Provider Demographics
NPI:1790029668
Name:CONCORD EYE CARE CENTER, O.D., P.A.
Entity Type:Organization
Organization Name:CONCORD EYE CARE CENTER, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-788-1170
Mailing Address - Street 1:2351 CONCORD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2813
Mailing Address - Country:US
Mailing Address - Phone:704-788-1170
Mailing Address - Fax:704-788-2165
Practice Address - Street 1:2351 CONCORD LAKE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2813
Practice Address - Country:US
Practice Address - Phone:704-788-1170
Practice Address - Fax:704-788-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2056152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty