Active NPI
Richard Anthony Shank, OD
- Optometrist
- Charlotte, NC
National Provider Identifier
1326168204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 972
- Practice address
- 9841 Northlake Centre Pkwy
Charlotte, NC 28216-8930 - Phone
- (707) 536-8733
- NPI assigned
- Apr 2, 2007
- Last updated
- Aug 14, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 972 | NC | Primary |
Addresses
Primary practice location
9841 Northlake Centre Pkwy
Charlotte, NC 28216-8930
Mailing address
5001 Isaac Dr
Charlotte, NC 28216-2015
Phone (704) 596-3028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090824000607 | NC | Practitioner - Optometry | 6204980345 | Practice locations: Charlotte, NC; Gastonia, NC |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 972 | NC | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250208000000",
"number": "1326168204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5001 ISAAC DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282162015",
"telephone_number": "704-596-3028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9841 NORTHLAKE CENTRE PKWY",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282168930",
"telephone_number": "707-536-8733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANK",
"first_name": "RICHARD",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2009-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "972",
"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 Aug 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.