Joel L Penegar OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

JOEL L PENEGAR OD PA

Practice address

1207 Skyway Dr
Monroe, NC 28110

Phone

(704) 296-0818

Fax

(704) 225-9115

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Joel L Penegar, OD

Title

Optometrist President

Phone

(704) 296-0818

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405036800000",
    "number": "1548303845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 SKYWAY DR",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "28110",
            "telephone_number": "704-296-0818",
            "fax_number": "704-225-9115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 SKYWAY DR",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "28110",
            "telephone_number": "704-296-0818",
            "fax_number": "704-225-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOEL L PENEGAR OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2014-07-11",
        "status": "A",
        "authorized_official_last_name": "PENEGAR",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OPTOMETRIST PRESIDENT",
        "authorized_official_telephone_number": "704-296-0818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "09703",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909703",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; 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.