Organization Active NPI

Metacare Inc

Doing business as EyeWatch LIVE

  • Gerontology Registered Nurse
  • Loganville, GA
National Provider Identifier
1023847662
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Registered NurseTaxonomy code 163WG0600X
Legal business name
METACARE INC
Doing business as
EyeWatch LIVE
Practice address
505 Plantation Park Dr Ste a
Loganville, GA 30052-4144
Phone
(800) 342-2507
NPI assigned
Jul 31, 2024
Last updated
Jul 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Authorized official

Name
Ms. Valerie Whitman
Title
President & Ceo
Phone
(781) 789-5167

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Registered Nurse 163WG0600X Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X

Addresses

Primary practice location

505 Plantation Park Dr Ste a
Loganville, GA 30052-4144

Mailing address

146 MLK Jr Blvd
Suite 267
Monroe, GA 30655
Phone (800) 342-2507

Other names 1

  • EyeWatch LIVE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250117001272 FL Part B Supplier - Clinic/Group Practice 7810426913 Receives reassigned benefits from 1 practitioner
Practice locations: Niceville, FL

National Provider Directory

National Provider Directory

Locations

1950 Bluewater Blvd
#20
Niceville, FL 32578
Phone (781) 789-5167

505 Plantation Park Dr
#A
Loganville, GA 30052
Phone (800) 342-2507

Practitioners & affiliated clinicians

Practitioners 1

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": "1722384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1023847662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 MLK JR BLVD",
            "address_2": "SUITE 267",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "30655",
            "telephone_number": "800-342-2507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 PLANTATION PARK DR STE A",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524144",
            "telephone_number": "800-342-2507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METACARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "WHITMAN",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "781-789-5167",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EyeWatch LIVE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.