Provider Demographics
NPI:1194823955
Name:CARTWRIGHT, STEPHANIE JOHNSON (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JOHNSON
Last Name:CARTWRIGHT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2474249Medicare PIN
NC5822360001Medicare NSC
NCV11415Medicare UPIN