Provider Demographics
NPI:1760676035
Name:DR. CHRISTOPHER K. MAUNEY OPTOMETRY, P.A.
Entity Type:Organization
Organization Name:DR. CHRISTOPHER K. MAUNEY OPTOMETRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAUNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-824-3401
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MC ADENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28101-0308
Mailing Address - Country:US
Mailing Address - Phone:704-824-3401
Mailing Address - Fax:704-824-3727
Practice Address - Street 1:355 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCADENVILLE
Practice Address - State:NC
Practice Address - Zip Code:28101
Practice Address - Country:US
Practice Address - Phone:704-824-3401
Practice Address - Fax:704-824-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890919WMedicaid
NC890919WMedicaid
NC4451150001Medicare NSC