NPIMap

Organization Active NPI

University Eye Associates, OD PA

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1205893435
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
UNIVERSITY EYE ASSOCIATES, OD PA
Practice address
9651 Brookdale Dr.
Suite 800
Charlotte, NC 28215-8105
Phone
(704) 536-6042
Fax
(704) 563-5917
NPI assigned
May 1, 2006
Last updated
Jun 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Authorized official

Name
Mrs. Kelly Alexander
Title
Administrator
Phone
(704) 547-1551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

9651 Brookdale Dr.
Suite 800
Charlotte, NC 28215-8105

Mailing address

9651 Brookdale Dr.
Suite 800
Charlotte, NC 28215-8105
Phone (704) 536-6042

Other identifiers 2

IdentifierTypeStateIssuer
09040OtherNCBLUE CROSS BLUE SHIELD
7909040MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031125000860 NC Part B Supplier - Clinic/Group Practice 0648174128 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Charlotte, NC
O20040731000349 NC Part B Supplier - Clinic/Group Practice 0648174128 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC; Davidson, NC
O20160416000013 NC DME Supplier - Physician - Optometrist 0648174128 Practice locations: Charlotte, NC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
University Eye Associates OD, PA9651 Brookdale Dr, Charlotte, NC 28215-8105(704) 536-6042 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jul 1, 1992

National Provider Directory

National Provider Directory
Tax ID family
University Eye Associates 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

8316 Medical Plaza Dr
Ste E
Charlotte, NC 28262
Phone (704) 547-1551

9651 Brookdale Dr
Ste 800
Charlotte, NC 28215
Phone (704) 536-6042

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1205893435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9651 BROOKDALE DR.",
            "address_2": "SUITE 800",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158105",
            "telephone_number": "704-536-6042",
            "fax_number": "704-563-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9651 BROOKDALE DR.",
            "address_2": "SUITE 800",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158105",
            "telephone_number": "704-536-6042",
            "fax_number": "704-563-5917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY EYE ASSOCIATES, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-01",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-547-1551",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "09040",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7909040",
            "state": "NC"
        }
    ],
    "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 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.