NPIMap

Organization Active NPI

Charlotte Optometry Group PA

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1295829380
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1458 Issued in NC
Legal business name
CHARLOTTE OPTOMETRY GROUP PA
Practice address
8701 JW Clay Blvd
Charlotte, NC 28262-5417
Phone
(704) 510-0816
Fax
(704) 510-0919
NPI assigned
Oct 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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.
Title
Vice President
Phone
(704) 510-0816

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1458 NC Primary

Addresses

Primary practice location

8701 JW Clay Blvd
Charlotte, NC 28262-5417

Mailing address

8701 JW Clay Blvd
Charlotte, NC 28262-5417
Phone (704) 510-0816

Other identifiers 3

IdentifierTypeStateIssuer
8381680OtherAETNA
0143TOtherBC/BS NC
890143TMedicaidNC

National Provider Directory

National Provider Directory

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": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295829380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8701 JW CLAY BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282625417",
            "telephone_number": "704-510-0816",
            "fax_number": "704-510-0919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 JW CLAY BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282625417",
            "telephone_number": "704-510-0816",
            "fax_number": "704-510-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE OPTOMETRY GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "704-510-0816",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "8381680",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NC",
            "identifier": "0143T",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890143T",
            "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.