NPIMap

Organization Active NPI

Olive Branch Eyecare, PLLC

  • Optometrist
  • Olive Branch, MS
National Provider Identifier
1003019878
Registry record updated Sep 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OLIVE BRANCH EYECARE, PLLC
Practice address
6947 Crumpler Blvd
Suite 100
Olive Branch, MS 38654-1922
Phone
(662) 893-3300
NPI assigned
Jun 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Lloyd Parker, O.D.NPI 1558321729
Title
Member
Phone
(662) 893-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

6947 Crumpler Blvd
Suite 100
Olive Branch, MS 38654-1922

Mailing address

6947 Crumpler Blvd
Suite 100
Olive Branch, MS 38654-1922
Phone (662) 893-3300

Other identifiers 2

IdentifierTypeStateIssuer
09577062MedicaidMS
DG2594OtherRAILROAD MEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070831000520 MS Part B Supplier - Clinic/Group Practice 4981797297 Receives reassigned benefits from 6 practitioners
Practice locations: Olive Branch, MS

National Provider Directory

National Provider Directory

Locations

6947 Crumpler Blvd
#100
Olive Branch, MS 38654
Phone (662) 893-3300

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221782400000",
    "number": "1003019878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6947 CRUMPLER BLVD",
            "address_2": "SUITE 100",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541922",
            "telephone_number": "662-893-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6947 CRUMPLER BLVD",
            "address_2": "SUITE 100",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541922",
            "telephone_number": "662-893-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE BRANCH EYECARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2008-09-19",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "LLOYD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "662-893-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09577062",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DG2594",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.