Provider Demographics
NPI:1295387637
Name:EXCEL EYECARE OD PA
Entity type:Organization
Organization Name:EXCEL EYECARE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:980-319-1870
Mailing Address - Street 1:13749 STEELE CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6841
Mailing Address - Country:US
Mailing Address - Phone:803-431-9474
Mailing Address - Fax:
Practice Address - Street 1:13749 STEELE CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6841
Practice Address - Country:US
Practice Address - Phone:980-319-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty