Provider Demographics
NPI:1154481331
Name:EYE CARE ASSOCIATES OF CHARLOTTE PLLC
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF CHARLOTTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:OLMSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-543-2020
Mailing Address - Street 1:123 LANSING STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813
Mailing Address - Country:US
Mailing Address - Phone:517-543-2020
Mailing Address - Fax:517-543-0311
Practice Address - Street 1:123 LANSING ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1696
Practice Address - Country:US
Practice Address - Phone:517-543-2020
Practice Address - Fax:517-543-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB9594OtherRAILROAD MEDICARE
MIOB37615OtherBCBS
1039600001Medicare NSC
OM15140Medicare ID - Type Unspecified