Charlotte Optometry Group PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

1458 Issued in NC

Legal business name

CHARLOTTE OPTOMETRY GROUP PA

Practice address

3061 N Sharon Amity Rd
Charlotte, NC 28205-6600

Phone

(704) 567-6755

Fax

(704) 567-0238

NPI assigned

Sep 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael James Johnson, O.D.

Title

Vice President

Phone

(704) 567-6755

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992805873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3061 N SHARON AMITY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282056600",
            "telephone_number": "704-567-6755",
            "fax_number": "704-567-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3061 N SHARON AMITY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282056600",
            "telephone_number": "704-567-6755",
            "fax_number": "704-567-0238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE OPTOMETRY GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "704-567-6755",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "807092",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "8381680",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890143T",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS NC",
            "identifier": "0143T",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlotte Operating Al, LLC
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• Charlotte Optometry Center, O.D., PLLC
• Charlotte Optometry Group PA
• Charlotte Orthodontics
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• Charlotte Pediatric Clinic
• Charlotte Pediatric Clinic
• 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 Aug 22, 2020; 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.