Provider Demographics
NPI:1083193411
Name:METROLINA EYE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:METROLINA EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-334-2020
Mailing Address - Street 1:630 COMFORT LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-6199
Mailing Address - Country:US
Mailing Address - Phone:704-289-5455
Mailing Address - Fax:704-291-2207
Practice Address - Street 1:2015 RANDOLPH RD STE 108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1200
Practice Address - Country:US
Practice Address - Phone:704-334-2020
Practice Address - Fax:704-334-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier