Provider Demographics
NPI:1932522406
Name:VISION CENTER OF LAKE NORMAN OD PA
Entity Type:Organization
Organization Name:VISION CENTER OF LAKE NORMAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:704-799-2020
Mailing Address - Street 1:125 COMMERCE PARK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7131
Mailing Address - Country:US
Mailing Address - Phone:704-799-2020
Mailing Address - Fax:704-774-4835
Practice Address - Street 1:125 COMMERCE PARK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7131
Practice Address - Country:US
Practice Address - Phone:704-799-2020
Practice Address - Fax:704-774-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2033152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty