MEDICARE: CAROLINA FAMILY EYE CARE OF BALLANTYNE, OD, 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
1	152W00000X	Optometrist	1816	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1816	OTHER	NC	LICENSE

General Provider Information

NPI Number	:	1871691485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FAMILY EYE CARE OF BALLANTYNE, OD, PLLC

Provider Business Mailing Address
First Line	:	12105 COPPER WAY
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-1756
Country	:	US
Telephone Number	:	704-295-4444
Fax Number	:	704-295-4443

Provider Business Practice Location Address
First Line	:	12105 COPPER WAY
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-1756
Country	:	US
Telephone Number	:	704-295-4444
Fax Number	:	704-295-4443

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID EUGENE LUPINSKI
Credential	:	OD
Telephone Number	:	704-295-4444

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/04/2026

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