Provider Demographics
NPI:1912170630
Name:MICHAEL D EMMETT
Entity Type:Organization
Organization Name:MICHAEL D EMMETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:EMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-827-2009
Mailing Address - Street 1:132 W CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1776
Mailing Address - Country:US
Mailing Address - Phone:704-827-2009
Mailing Address - Fax:704-827-0435
Practice Address - Street 1:132 W CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1776
Practice Address - Country:US
Practice Address - Phone:704-827-2009
Practice Address - Fax:704-827-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1189760001Medicare NSC