Charlotte Optometry Center, O.D., PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1924 Issued in NC

Legal business name

CHARLOTTE OPTOMETRY CENTER, O.D., PLLC

Practice address

8701 JW Clay Blvd
Charlotte, NC 28262-5417

Phone

(704) 510-0816

NPI assigned

Jan 3, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Carol Dudley, O.D.NPI 1891719845

Title

Managing Partner

Phone

(704) 510-0816

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Carol Dudley, O.D.

  • Optometrist
  • Charlotte, NC
  • NPI 1891719845
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1558782821",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE OPTOMETRY CENTER, O.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-03",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "704-510-0816",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89093R5",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Charlotte Optometry Group PA
• Charlotte Optometry Group PA
• Charlotte Orthodontics
• Charlotte Pain Associates PA
• Charlotte Pediatric Clinic

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.