Provider Demographics
NPI:1497982482
Name:STEPHANIE JOHNSON CARTWRIGHT, O.D. PLLC
Entity Type:Organization
Organization Name:STEPHANIE JOHNSON CARTWRIGHT, O.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:CARTWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-835-2244
Mailing Address - Street 1:1816 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2104
Mailing Address - Country:US
Mailing Address - Phone:336-835-2244
Mailing Address - Fax:
Practice Address - Street 1:1816 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2104
Practice Address - Country:US
Practice Address - Phone:336-835-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1908332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCV11415Medicare UPIN
NC6186600001Medicare NSC