NPIMap

Organization Active NPI

David Wichnoski, O.D. , P.a.

Doing business as Spectrum Eye Care

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1114045085
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1632 Issued in NC
Legal business name
DAVID WICHNOSKI, O.D. , P.A.
Doing business as
Spectrum Eye Care
Practice address
7615 Colony Rd
Ste 105
Charlotte, NC 28226
Phone
(704) 543-9000
Fax
(704) 543-9002
NPI assigned
Mar 27, 2007
Last updated
Jun 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Joseph Wichnoski, ODNPI 1790866069
Title
President
Phone
(704) 543-9000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1632 NC Primary

Addresses

Primary practice location

7615 Colony Rd
Ste 105
Charlotte, NC 28226

Mailing address

7615 Colony Rd
Ste 105
Charlotte, NC 28226
Phone (704) 543-9000

Other identifiers 1

IdentifierTypeStateIssuer
89090SLMedicaidNC

Other names 1

  • Spectrum Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080509000472 NC Part B Supplier - Clinic/Group Practice 1052490257 Receives reassigned benefits from 8 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory
Tax ID family
David Wichnoski OD PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 S College St
Ste 307
Charlotte, NC 28202
Phone (704) 334-4444

7615 Colony Rd
Ste 105
Charlotte, NC 28226
Phone (704) 543-9000

7731 Colony Rd
Ste F2
Charlotte, NC 28226
Phone (704) 543-9000

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1114045085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7615 COLONY RD",
            "address_2": "STE 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28226",
            "telephone_number": "704-543-9000",
            "fax_number": "704-543-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7615 COLONY RD",
            "address_2": "STE 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28226",
            "telephone_number": "704-543-9000",
            "fax_number": "704-543-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID WICHNOSKI, O.D. , P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "WICHNOSKI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-543-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89090SL",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.