Healthcare Provider Details

I. General information

NPI: 1033162714
Provider Name (Legal Business Name): MICHAEL DARREN EMMETT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W CHARLOTTE AVE
MOUNT HOLLY NC
28120-1776
US

IV. Provider business mailing address

132 W CHARLOTTE AVE
MOUNT HOLLY NC
28120-1776
US

V. Phone/Fax

Practice location:
  • Phone: 704-827-2009
  • Fax: 704-827-0435
Mailing address:
  • Phone: 704-827-2009
  • Fax: 704-827-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNC1257
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: