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NPI Code Detail

MEDICARE: EYE CARE ASSOCIATES OF CHARLOTTE PLLC

MEDICARE: EYE CARE ASSOCIATES OF CHARLOTTE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB9594OTHERMIRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2OB37615OTHERMIBCBS

General Provider Information

NPI Number : 1154481331
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE CARE ASSOCIATES OF CHARLOTTE PLLC
Provider Business Mailing Address
First Line : 123 LANSING STREET
Second Line :
City : CHARLOTTE
State : MI
Zip : 48813
Country : US
Telephone Number : 517-543-2020
Fax Number : 517-543-0311
Provider Business Practice Location Address
First Line : 123 LANSING ST
Second Line :
City : CHARLOTTE
State : MI
Zip : 48813-1696
Country : US
Telephone Number : 517-543-2020
Fax Number : 517-543-0311
Authorized Official
Title or Position : CO OWNER OPTOMETRIST
Name : DR. ALLEN DENNIS OLMSTEAD
Credential : OD
Telephone Number : 517-543-2020
Provider Enumeration Date : 12/11/2006
Last Update Date : 06/22/2010

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Directions to “EYE CARE ASSOCIATES OF CHARLOTTE PLLC ” Practice Location

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