Provider Demographics
NPI:1063896777
Name:METROLINA EYE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:METROLINA EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-774-1180
Mailing Address - Street 1:630 COMFORT LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-6199
Mailing Address - Country:US
Mailing Address - Phone:704-289-5455
Mailing Address - Fax:704-291-2207
Practice Address - Street 1:6237 CAROLINA COMMONS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-6014
Practice Address - Country:US
Practice Address - Phone:804-547-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier