NPIMap

Organization Active NPI

Vision Center of Lake Norman OD PA

  • Optometrist
  • Mooresville, NC
National Provider Identifier
1932522406
Registry record updated Feb 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2033 Issued in NC
Legal business name
VISION CENTER OF LAKE NORMAN OD PA
Practice address
125 Commerce Park Rd
Suite 103
Mooresville, NC 28117-7131
Phone
(704) 799-2020
Fax
(704) 774-4835
NPI assigned
Feb 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2014

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

Authorized official

Name
Dr. Robert C Monson III, ODNPI 1639238868
Title
President
Phone
(704) 799-2020

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 2033 NC Primary

Addresses

Primary practice location

125 Commerce Park Rd
Suite 103
Mooresville, NC 28117-7131

Mailing address

125 Commerce Park Rd
Suite 103
Mooresville, NC 28117-7131
Phone (704) 799-2020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140226000407 NC Part B Supplier - Clinic/Group Practice 5395975049 Receives reassigned benefits from 4 practitioners
Practice locations: Mooresville, NC; Newton, NC

National Provider Directory

National Provider Directory

Locations

125 Commerce Park Rd
Ste 103
Mooresville, NC 28117
Phone (704) 799-2020

Practitioners & affiliated clinicians

Practitioners 5

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": "1391385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1932522406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 COMMERCE PARK RD",
            "address_2": "SUITE 103",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177131",
            "telephone_number": "704-799-2020",
            "fax_number": "704-774-4835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 COMMERCE PARK RD",
            "address_2": "SUITE 103",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281177131",
            "telephone_number": "704-799-2020",
            "fax_number": "704-774-4835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION CENTER OF LAKE NORMAN OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-03",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "MONSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-799-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.