Provider Demographics
NPI:1548409824
Name:DOUBLE VISION INC
Entity Type:Organization
Organization Name:DOUBLE VISION INC
Other - Org Name:NORTHLAKE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/ OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZANETTA
Authorized Official - Middle Name:BELLAMY
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-598-4300
Mailing Address - Street 1:6801 NORTHLAKE MALL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0711
Mailing Address - Country:US
Mailing Address - Phone:704-598-4300
Mailing Address - Fax:704-598-4326
Practice Address - Street 1:6801 NORTHLAKE MALL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0711
Practice Address - Country:US
Practice Address - Phone:704-598-4300
Practice Address - Fax:704-598-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC477332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier