NPIMap

Organization Active NPI

Carolina Family Eye Care OD PLLC

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1700970423
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1714 Issued in NC
Legal business name
CAROLINA FAMILY EYE CARE OD PLLC
Practice address
2424 W Mallard Creek Church Rd
Ste D
Charlotte, NC 28262-5800
Phone
(704) 295-0123
Fax
(704) 510-9239
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Authorized official

Name
Dr. Amir Khoshnevis, ODNPI 1346242781
Title
Physician/Owner
Phone
(704) 295-0123

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1714 NC Primary

Addresses

Primary practice location

2424 W Mallard Creek Church Rd
Ste D
Charlotte, NC 28262-5800

Mailing address

2424 W Mallard Creek Church Rd
Ste D
Charlotte, NC 28262-5800
Phone (704) 295-0123

Other identifiers 3

IdentifierTypeStateIssuer
017GHOtherNCBLUE CROSS BLUE SHIELD
1346242781OtherNCNPI
89093JGMedicaidNC

Other names 1

  • Vision Source Studio 20/20 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080527000608 NC Part B Supplier - Clinic/Group Practice 8123197597 Receives reassigned benefits from 4 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

2424 W Mallard Creek Church Rd
Ste D
Charlotte, NC 28262
Phone (704) 295-0123

8220 University Exec Park Dr
Ste 130
Charlotte, NC 28262
Phone (704) 295-0123

Practitioners & affiliated clinicians

Practitioners 7

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

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": "1591315200000",
    "number": "1700970423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 W MALLARD CREEK CHURCH RD",
            "address_2": "STE D",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282625800",
            "telephone_number": "704-295-0123",
            "fax_number": "704-510-9239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 W MALLARD CREEK CHURCH RD",
            "address_2": "STE D",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282625800",
            "telephone_number": "704-295-0123",
            "fax_number": "704-510-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA FAMILY EYE CARE OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "KHOSHNEVIS",
        "authorized_official_first_name": "AMIR",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "704-295-0123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "017GH",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1346242781",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89093JG",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source Studio 20/20",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 5, 2020; 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.