Provider Demographics
NPI:1700839305
Name:METROLINA EYE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:METROLINA EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-234-1934
Mailing Address - Street 1:630 COMFORT LANE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-6493
Mailing Address - Country:US
Mailing Address - Phone:704-289-5455
Mailing Address - Fax:704-291-2207
Practice Address - Street 1:630 COMFORT LANE
Practice Address - Street 2:SUITE E
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-6493
Practice Address - Country:US
Practice Address - Phone:704-289-5455
Practice Address - Fax:704-291-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016P7Medicaid
NC2339306Medicare PIN
NC5442380001Medicare NSC
5442380001Medicare NSC