Provider Demographics
NPI:1144322058
Name:PIEDMONT EYE CARE ASSOCIATES, OD, PLLC
Entity type:Organization
Organization Name:PIEDMONT EYE CARE ASSOCIATES, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-926-3937
Mailing Address - Street 1:8811 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6598
Mailing Address - Country:US
Mailing Address - Phone:704-926-3937
Mailing Address - Fax:704-926-3938
Practice Address - Street 1:8811 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6598
Practice Address - Country:US
Practice Address - Phone:704-926-3937
Practice Address - Fax:704-926-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3471651OtherAETNA HMO
7148542OtherAETNA NON-HMO
015NYOtherBC/BS NC
015NYOtherBC/BS NC
7148542OtherAETNA NON-HMO