Provider Demographics
NPI:1497719462
Name:VINCENT, TONIMARIE (D,O,)
Entity Type:Individual
Prefix:DR
First Name:TONIMARIE
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:D,O,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 ALBEMARLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-3630
Mailing Address - Country:US
Mailing Address - Phone:704-537-2020
Mailing Address - Fax:704-537-0578
Practice Address - Street 1:5534 ALBEMARLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-3630
Practice Address - Country:US
Practice Address - Phone:704-537-2020
Practice Address - Fax:704-537-0578
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1272152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU12785Medicare UPIN