Provider Demographics
NPI:1447898754
Name:MAGNOLIA EYE CARE, O.D. PLLC
Entity type:Organization
Organization Name:MAGNOLIA EYE CARE, O.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-407-7197
Mailing Address - Street 1:PO BOX 2349
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-2349
Mailing Address - Country:US
Mailing Address - Phone:336-407-7197
Mailing Address - Fax:
Practice Address - Street 1:141 SPRUCE PINE WAY
Practice Address - Street 2:SUITE C
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021
Practice Address - Country:US
Practice Address - Phone:336-407-7197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty