NPIMap

Organization Active NPI

Piedmont Eye Care Associates, OD, PLLC

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1144322058
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1458 Issued in NC
Legal business name
PIEDMONT EYE CARE ASSOCIATES, OD, PLLC
Practice address
8811 Blakeney Professional Dr
Suite 100
Charlotte, NC 28277-6598
Phone
(704) 926-3937
Fax
(704) 926-3938
NPI assigned
Sep 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

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

Authorized official

Name
Dr. Michael James Johnson, O.D.NPI 1841391471
Title
Member
Phone
(704) 926-3937

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 1458 NC Primary

Addresses

Primary practice location

8811 Blakeney Professional Dr
Suite 100
Charlotte, NC 28277-6598

Mailing address

8811 Blakeney Professional Dr
Suite 100
Charlotte, NC 28277-6598
Phone (704) 926-3937

Other identifiers 3

IdentifierTypeStateIssuer
3471651OtherAETNA HMO
7148542OtherAETNA NON-HMO
015NYOtherBC/BS NC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040223001219 NC Part B Supplier - Clinic/Group Practice 7012803570 Receives reassigned benefits from 9 practitioners
Practice locations: Charlotte, NC; Wesley Chapel, NC

National Provider Directory

National Provider Directory

Locations

8811 Blakeney Professional Dr
Ste 100
Charlotte, NC 28277
Phone (704) 926-3937

5925 Weddington Rd
#102
Matthews, NC 28104

5943 Weddington Rd
Ste 104
Matthews, NC 28104

5955 Weddington Rd
Ste 102
Wesley Chapel, NC 28104
Phone (704) 926-3937

Practitioners & affiliated clinicians

Practitioners 9

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": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1144322058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8811 BLAKENEY PROFESSIONAL DR",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776598",
            "telephone_number": "704-926-3937",
            "fax_number": "704-926-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8811 BLAKENEY PROFESSIONAL DR",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776598",
            "telephone_number": "704-926-3937",
            "fax_number": "704-926-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT EYE CARE ASSOCIATES, OD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "704-926-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3471651",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "7148542",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NC",
            "identifier": "015NY",
            "state": null
        }
    ],
    "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 Jun 30, 2015; 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.