NPIMap

Organization Active NPI

Eyecare One Martinez LLC

  • Optometrist
  • Evans, GA
National Provider Identifier
1043437486
Registry record updated Jul 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
848T Issued in GA
Legal business name
EYECARE ONE MARTINEZ LLC
Practice address
510 North Belair Rd
Evans, GA 30809
Phone
(706) 863-3030
Fax
(706) 863-0093
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2009

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

Authorized official

Name
Dr. Paul Wesley Broome, ODNPI 1083672422
Title
President Owner
Phone
(706) 863-3030

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 848T GA Primary

Addresses

Primary practice location

510 North Belair Rd
Evans, GA 30809

Mailing address

510 North Belair Rd
Evans, GA 30809
Phone (706) 863-3030

Other identifiers 1

IdentifierTypeStateIssuer
52159903OtherGABLUE CROSS BLUE SHIELD

Other names 1

  • Broome Family Eyecare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060324000453 GA Part B Supplier - Clinic/Group Practice 2163430679 Receives reassigned benefits from 5 practitioners
Practice locations: Evans, GA

National Provider Directory

National Provider Directory

Locations

3153 Washington Rd
Augusta, GA 30907
Phone (706) 863-3030

510 N Belair Rd
Evans, GA 30809
Phone (706) 863-3030

Practitioners & affiliated clinicians

Practitioners 7

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": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247529600000",
    "number": "1043437486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 NORTH BELAIR RD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "30809",
            "telephone_number": "706-863-3030",
            "fax_number": "706-863-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 NORTH BELAIR RD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "30809",
            "telephone_number": "706-863-3030",
            "fax_number": "706-863-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE ONE MARTINEZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2009-07-14",
        "status": "A",
        "authorized_official_last_name": "BROOME",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "706-863-3030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "848T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52159903",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broome Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2009; 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.