NPIMap

Organization Active NPI

University Eye Associates, OD PA

  • Optometrist
  • Davidson, NC
National Provider Identifier
1912965989
Registry record updated Feb 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
UNIVERSITY EYE ASSOCIATES, OD PA
Practice address
455 S Main St
Suite 100
Davidson, NC 28036-8019
Phone
(704) 896-9090
Fax
(704) 896-9680
NPI assigned
May 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2008

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

Authorized official

Name
Michelle Carson
Title
Practice Billing & Insurance Manage
Phone
(704) 547-1551

Specialties & licenses 1

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

Addresses

Primary practice location

455 S Main St
Suite 100
Davidson, NC 28036-8019

Mailing address

455 S Main St
Suite 100
Davidson, NC 28036-8019
Phone (704) 896-9090

Other identifiers 2

IdentifierTypeStateIssuer
89014N9MedicaidNC
014PMOtherNCBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040731000349 NC Part B Supplier - Clinic/Group Practice 0648174128 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC; Davidson, NC
O20180126002686 NC DME Supplier - Physician - Optometrist 0648174128 Practice locations: Davidson, NC

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
University Eye Associates OD, PA455 S Main St, Davidson, NC 28036-8021(704) 896-9090 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jul 1, 1992

National Provider Directory

National Provider Directory
Tax ID family
University Eye Associates OD PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6604 E Wt Harris Blvd
Charlotte, NC 28215
Phone (704) 536-6042

455 S Main St
Ste 100
Davidson, NC 28036
Phone (704) 896-9090

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1912965989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "address_2": "SUITE 100",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368019",
            "telephone_number": "704-896-9090",
            "fax_number": "704-896-9680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "address_2": "SUITE 100",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368019",
            "telephone_number": "704-896-9090",
            "fax_number": "704-896-9680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY EYE ASSOCIATES, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-01",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRACTICE BILLING & INSURANCE MANAGE",
        "authorized_official_telephone_number": "704-547-1551"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89014N9",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "014PM",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davidson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.