NPIMap

Organization Active NPI

Innovative Eye Care OD PLLC

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1114201936
Registry record updated Feb 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2225 Issued in NC
Legal business name
INNOVATIVE EYE CARE OD PLLC
Practice address
1710 Kenilworth Ave
Suite 210
Charlotte, NC 28203-5256
Phone
(704) 348-1500
NPI assigned
Sep 29, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2012

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

Authorized official

Name
Dr. Michelle Kathleen Mumford, O.D.NPI 1821235706
Title
Owner
Phone
(704) 348-1500

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2225 NC Primary

Addresses

Primary practice location

1710 Kenilworth Ave
Suite 210
Charlotte, NC 28203-5256

Mailing address

1710 Kenilworth Ave
Suite 210
Charlotte, NC 28203-5256
Phone (704) 348-1500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111005000043 NC Part B Supplier - Clinic/Group Practice 0042482515 Receives reassigned benefits from 4 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

1710 Kenilworth Ave
Ste 210
Charlotte, NC 28203
Phone (704) 348-1500

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1317254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330387200000",
    "number": "1114201936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 KENILWORTH AVE",
            "address_2": "SUITE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035256",
            "telephone_number": "704-348-1500",
            "fax_number": "704-919-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 KENILWORTH AVE",
            "address_2": "SUITE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035256",
            "telephone_number": "704-348-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE EYE CARE OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-29",
        "last_updated": "2012-02-28",
        "status": "A",
        "authorized_official_last_name": "MUMFORD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "KATHLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-348-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Feb 28, 2012; 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.