Provider Demographics
NPI:1598167793
Name:LVI OF CHARLOTTE
Entity Type:Organization
Organization Name:LVI OF CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-584-4150
Mailing Address - Street 1:2525 MERIDIAN PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5243
Mailing Address - Country:US
Mailing Address - Phone:919-316-1977
Mailing Address - Fax:
Practice Address - Street 1:2000 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6503
Practice Address - Country:US
Practice Address - Phone:561-965-9110
Practice Address - Fax:706-243-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery