Individual provider Active NPI

Amanda Heyward, OD

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1518489723
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2506 Issued in NC
Practice address
8811 Blakeney Professional Dr Ste 100
Charlotte, NC 28277-6599
Phone
(980) 333-6012
NPI assigned
Jul 10, 2017
Last updated
Oct 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2000 SC
Optometrist 152W00000X 2506 NC Primary

Addresses

Primary practice location

8811 Blakeney Professional Dr Ste 100
Charlotte, NC 28277-6599

Mailing address

3512 Ritch Ave
Charlotte, NC 28206-2014

Other practice location 1

1601 Brenner Ave
Salisbury, NC 28144-2515
Phone (704) 638-9000

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200316000126 NC Practitioner - Optometry 8527496173 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2501 The PLZ
Suite 2
Charlotte, NC 28205-2407
Phone (704) 317-7717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2000SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Midwood Eye Optometry PLLC Optometrist CurrentSince Jul 17, 2020 Accepting new patients
Ryan Leblanc OD PLLC Optometrist CurrentSince Feb 1, 2022 Accepting new patients

Locations

2501 The Plaza
Ste 2
Charlotte, NC 28205
Phone (704) 317-7717

7735 N Tryon St
Charlotte, NC 28262
Phone (704) 547-0305

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1518489723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3512 RITCH AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282062014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8811 BLAKENEY PROFESSIONAL DR STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282776599",
            "telephone_number": "980-333-6012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 Brenner Ave",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "NC",
            "postal_code": "281442515",
            "country_code": "US",
            "telephone_number": "704-638-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEYWARD",
        "first_name": "AMANDA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-10",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "2000",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.