Provider Demographics
NPI:1033162714
Name:EMMETT, MICHAEL DARREN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DARREN
Last Name:EMMETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1776
Mailing Address - Country:US
Mailing Address - Phone:704-827-2009
Mailing Address - Fax:704-827-0435
Practice Address - Street 1:132 W CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1776
Practice Address - Country:US
Practice Address - Phone:704-827-2009
Practice Address - Fax:704-827-0435
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890918GMedicaid
NCT65062Medicare UPIN
NC1189760001Medicare NSC
NC890918GMedicaid