PROVIDENCE EYE AND LASER SPECIALISTS, PC
NPI 1154367217
Optometrist in Charlotte, NC

Q: What is Providence Eye And Laser Specialists, PC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Active since June 20, 2006CLIA 34D2159224 · Waiver

3025 SPRINGBANK LN, SUITE 200, CHARLOTTE, NC 28226(704) 540-9595(704) 540-9616 Get Directions Write a Review

NPPES record last updated: October 16, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Providence Eye And Laser Specialists, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE EYE AND LASER SPECIALISTS, PC (NPI 1154367217) is a healthcare organization registered as an optometrist in Charlotte, North Carolina and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through December 13, 2026 and lists Rey Wilson, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1154367217

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NamePROVIDENCE EYE AND LASER SPECIALISTS, PC

Location Address3025 SPRINGBANK LN, SUITE 200Charlotte, NC 28226-3362

Mailing Address3025 Springbank Ln, Suite 200Charlotte, NC 28226-3362 · (704) 540-9595 · Fax (704) 540-9616

Phone(704) 540-9595

Fax(704) 540-9616

Organization SubpartNo

Authorized OfficialRey WilsonOffice Manager · (704) 540-9595

Enumeration DateJune 20, 2006

Last NPPES UpdateOctober 16, 2012

✔ NPI 1154367217 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in NC · 2000-00102

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

3025 SPRINGBANK LN, Charlotte, NC 28226

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Other Identifiers 1

Medicare PIN2330965NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Eye And Laser Specialists, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Providence Eye And Laser Specialists, PC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Jasmine Suggs, OD

Optometry

NPI 1538762992

7808 S TRYON ST STE D&E
Charlotte, NC 28273

(704) 522-8000

✔ PECOS✔ Accepts Medicare8.9 mi

Daniel Gray, OD

Optometry

NPI 1366435729

1975 HIGH HOUSE RD
Cary, NC 27519

(919) 461-0771

✔ PECOS✔ Accepts Medicare119 mi

Edwin Nunnery Iii, M.D.

Ophthalmology

NPI 1083057756

1364 CLIFTON RD NE
Atlanta, GA 30322

(404) 778-0263

✔ PECOS✔ Accepts Medicare221 mi

Valerie Chen, MD

Ophthalmology

NPI 1750624987

1220 NEW SCOTLAND RD STE 302
Slingerlands, NY 12159

(518) 533-6540

✔ PECOS✔ Accepts Medicare640 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2159224

Providence Eye And Laser Specialists · Charlotte, NC

Active · expires Dec 13, 2026

CLIA Number34D2159224

Laboratory TypePhysician Office

Certificate Effective DateDecember 14, 2024

Certificate Expiration DateDecember 13, 2026

Laboratory DirectorReza M. Mozayeni

Laboratory Phone(704) 540-9595

Laboratory LocationProvidence Eye And Laser Specialists3025 Spring Bank Lane, Suite 200, Charlotte, NC 28226

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Eye And Laser Specialists, PC's NPI number?

The NPI number for Providence Eye And Laser Specialists, PC is 1154367217. It was assigned to this organization in the NPPES registry on June 20, 2006.

Where is Providence Eye And Laser Specialists, PC located?

Providence Eye And Laser Specialists, PC is located at 3025 Springbank Ln Suite 200, Charlotte, NC 28226. The listed phone number is (704) 540-9595.

What is Providence Eye And Laser Specialists, PC's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Providence Eye And Laser Specialists, PC enrolled in Medicare?

Yes. Providence Eye And Laser Specialists, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Eye And Laser Specialists, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Providence Eye And Laser Specialists, PC, in Ophthalmology and Optometry. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Providence Eye And Laser Specialists, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2159224) is associated with this NPI, valid through December 13, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Providence Eye And Laser Specialists, PC accept?

Health plans from Blue Cross and Blue Shield of NC list Providence Eye And Laser Specialists, PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Providence Eye And Laser Specialists, PC was last updated on October 16, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.