Alyssa Mackenzie Childers-Pittman, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618002316 Issued in VA

Practice address

530 E Main St
Purcellville, VA 20132-3171

Phone

(540) 338-1833

NPI assigned

Aug 1, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Alyssa Mackenzie Childers Former name

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dilzer Eye Care Associates, P.C.

  • Optometrist
  • Purcellville, VA
  • NPI 1871615542
  Medicare reassignment NPD
• Lightbenders PLLC

  • Optometrist
  • Bridgeport, WV
  • NPI 1396383907
  NPD (past)
• Murray Murray and Groves Inc

  • Optometrist
  • Bridgeport, WV
  • NPI 1134263262
  NPD (past)

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

{
    "created_epoch": "1343779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438041600000",
    "number": "1023364601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 E MAIN ST",
            "city": "PURCELLVILLE",
            "state": "VA",
            "postal_code": "201323171",
            "telephone_number": "540-338-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 E MAIN ST",
            "city": "PURCELLVILLE",
            "state": "VA",
            "postal_code": "201323171",
            "telephone_number": "540-338-1833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDERS-PITTMAN",
        "first_name": "ALYSSA",
        "middle_name": "MACKENZIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-01",
        "last_updated": "2015-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "1095-IOD",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG002638",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "6112",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "VVE942A",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "CHILDERS",
            "middle_name": "MACKENZIE",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Optometrist in Purcellville, VA
• Providers in Purcellville, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.