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

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: August 02, 2026.

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 ›

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.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEPHANIE YOUNG SIMON MD
Internal Medicine
3025 SPRINGBANK LN, STE 100
CHARLOTTE, NC 28226
Mecklenburg County (704) 446-2620
NADINE AHMED EL KOMY DO
Internal Medicine
3025 SPRINGBANK LN
CHARLOTTE, NC 28226
Mecklenburg County (704) 446-2620
DR. ENAMUL HAQUE M.D.
Surgery (Surgery of the Hand)
3025 SPRINGBANK LN, STE #240
CHARLOTTE, NC 28226
Mecklenburg County (704) 372-5685
CHARLOTTE MEDICAL CLINIC INC
Dermatology
3025 SPRINGBANK LN, STE 100
CHARLOTTE, NC 28226
Mecklenburg County (704) 446-2620
QUEEN CITY PLASTIC SURGERY PLLC
Plastic Surgery
3025 SPRINGBANK LN, SUITE 240
CHARLOTTE, NC 28226
Mecklenburg County (704) 372-5685
MATTHEW CHRISTIAN ANDERSON MD
Internal Medicine
3025 SPRINGBANK LN, STE 100
CHARLOTTE, NC 28226
Mecklenburg County (704) 446-2620
ERIN HERRICK HAYNES DO
Internal Medicine
3025 SPRINGBANK LN, STE 100
CHARLOTTE, NC 28226
Mecklenburg County (704) 446-2620
KATIE NICOLE ELLIOTT PA
Physician Assistant
3025 SPRINGBANK LN, STE 100
CHARLOTTE, NC 28226
Mecklenburg County (704) 446-2620

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.

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 13 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.