Provider Demographics
NPI:1801846357
Name:SPICOLA, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SPICOLA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:10305 HAMPTONS PARK DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7217
Practice Address - Country:US
Practice Address - Phone:704-295-3600
Practice Address - Fax:704-892-3181
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410044201OtherRAILROAD MEDICARE
NC2241972OtherUNITED HEALTHCARE
NC36143OtherPARTNERS
NC299893OtherMAMSI
NC890926JMedicaid
NC0926JOtherBCBS
NC23238OtherBCBS MEDPOINT
NC9025680OtherCIGNA HEALTHCARE
SCDN1514Medicaid
SC20096164OtherSELECT HEALTH OF SC
NC87787OtherMEDCOST
SC20096164OtherSELECT HEALTH OF SC
NC23238OtherBCBS MEDPOINT
NC890926JMedicaid