Providence Eye and Laser Specialists, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2000-00102 Issued in NC

Legal business name

PROVIDENCE EYE AND LASER SPECIALISTS, PC

Practice address

3025 Springbank LN
Suite 200
Charlotte, NC 28226-3362

Phone

(704) 540-9595

Fax

(704) 540-9616

NPI assigned

Jun 20, 2006

Organization subpart

No

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

Authorized official

Name

Rey Wilson

Title

Office Manager

Phone

(704) 540-9595

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

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

• Daniel Gray, OD

  • Optometrist
  • Cary, NC
  • NPI 1366435729
  Medicare reassignment Care Compare group NPD
• Jasmine Monique Suggs, OD

  • Optometrist
  • Charlotte, NC
  • NPI 1538762992
  Medicare reassignment Care Compare group NPD
• Valerie Chen, MD

  • Ophthalmology Physician
  • Slingerlands, NY
  • NPI 1750624987

  NC

  Medicare reassignment Care Compare group NPD
• Edwin Nunnery III, M.D.

  • Ophthalmology Physician
  • Atlanta, GA
  • NPI 1083057756

  NC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1154367217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3025 SPRINGBANK LN",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282263362",
            "telephone_number": "704-540-9595",
            "fax_number": "704-540-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 SPRINGBANK LN",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282263362",
            "telephone_number": "704-540-9595",
            "fax_number": "704-540-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE EYE AND LASER SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "REY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "704-540-9595"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2000-00102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Anesthesiology Associates, P.a.
• Providence Anesthesiology Associates, P.a.
• Providence Behavioral Health
• Providence Behavioral Health PA
• Providence Counseling & Training, Inc.
• Providence Family Psychiatry
• Providence Health Center
• Providence Pediatrics
• Providence Physical Medicine PC
• Providence Psychiatric & Behavioral Health Services, Inc

• Optometrist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.