NPIMap

Organization Active NPI

Decatur Family Eye Care LLC

  • Optometrist
  • Decatur, AL
National Provider Identifier
1023594603
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S-E06 Issued in AL
Legal business name
DECATUR FAMILY EYE CARE LLC
Practice address
1313 13TH Ave SE
Decatur, AL 35601-4308
Phone
(256) 353-1787
Fax
(256) 350-6041
NPI assigned
Jul 17, 2018
Last updated
Jul 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Authorized official

Name
Jonathan Davis, ODNPI 1346745817
Title
Owner/Optometrist
Phone
(662) 571-1654

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
Optometrist 152W00000X S-E06 AL Primary

Addresses

Primary practice location

1313 13TH Ave SE
Decatur, AL 35601-4308

Mailing address

1313 13TH Ave SE
Decatur, AL 35601-4308
Phone (256) 353-1787

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181017001886 AL Part B Supplier - Clinic/Group Practice 6608128715 Receives reassigned benefits from 3 practitioners
Practice locations: Decatur, AL

National Provider Directory

National Provider Directory

Locations

1313 13th Ave SE
Decatur, AL 35601
Phone (256) 353-1787

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531785600000",
    "number": "1023594603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 13TH AVE SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356014308",
            "telephone_number": "256-353-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 13TH AVE SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356014308",
            "telephone_number": "256-353-1787",
            "fax_number": "256-350-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR FAMILY EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "last_updated": "2018-07-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "662-571-1654",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-E06",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; 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.