Organization Active NPI

Rocky Mount Eye PA

  • Ophthalmology Physician
  • Rocky Mount, NC
National Provider Identifier
1043691595
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
ROCKY MOUNT EYE PA
Practice address
450 Jones Rd
Rocky Mount, NC 27804-8207
Phone
(252) 443-1006
Fax
(252) 937-8366
NPI assigned
Jun 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2021

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

Authorized official

Name
Thomas J Robertson Jr., M.D.NPI 1154382612
Title
Owner
Phone
(252) 443-1006

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

450 Jones Rd
Rocky Mount, NC 27804-8207

Mailing address

450 Jones Rd
Rocky Mount, NC 27804-8207
Phone (252) 443-1006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150902002171 NC Part B Supplier - Clinic/Group Practice 1557677739 Receives reassigned benefits from 9 practitioners
Practice locations: Rocky Mount, NC
O20160617002030 NC DME Supplier - Physician - Ophthalmology 1557677739 Practice locations: Rocky Mount, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2109000Rocky Mount Eye PA450 Jones Road, Rocky Mount, NC 27804Certificate of waiverFeb 16, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1433894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1043691595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 JONES RD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278048207",
            "telephone_number": "252-443-1006",
            "fax_number": "252-937-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 JONES RD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278048207",
            "telephone_number": "252-443-1006",
            "fax_number": "252-937-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNT EYE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-10",
        "last_updated": "2021-10-15",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-443-1006",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rocky Mount, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.