Provider Demographics
NPI:1447210273
Name:METWALLI, MAGDA MEKKY (OD)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:MEKKY
Last Name:METWALLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 MEDICAL PLAZA DR STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6704
Mailing Address - Country:US
Mailing Address - Phone:704-547-1551
Mailing Address - Fax:
Practice Address - Street 1:8316 MEDICAL PLAZA DR STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6704
Practice Address - Country:US
Practice Address - Phone:704-547-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1903628OtherUNITED HEALTHCARE
NC890925NMedicaid
NC0925NOtherBCBS
NC0485250003Medicare NSC
NC2471187BMedicare PIN
NCU59392Medicare UPIN
NC0485250001Medicare NSC
NC2471187AMedicare PIN