Organization
CHARLOTTE OPTOMETRY GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JAMES JOHNSON O.D. (VICE PRESIDENT)
(704) 510-0816
Entity
Organization
Contact information
Practice address
8701 JW CLAY BLVD, CHARLOTTE, NC 28262-5417
(704) 510-0816
(704) 510-0919
Mailing address
8701 JW CLAY BLVD, CHARLOTTE, NC 28262-5417
(704) 510-0816
(704) 510-0919
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1458
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0143T
BC/BS NC
—
01
—
8381680
AETNA
—
05
—
890143T
—
NC
Enumeration date
10/03/2006
Last updated
08/22/2020
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