Professional Eye Care Optometry, PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PROFESSIONAL EYE CARE OPTOMETRY, PA

Practice address

432 W Broad St
Elizabethtown, NC 28337

Phone

(910) 991-3003

Fax

(910) 991-3057

NPI assigned

Jun 24, 2019

Organization subpart

No

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

Authorized official

Name

Enid Rosario-McCullough

Title

Credentialing

Phone

(910) 423-0700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Professional Eye Care Optometry, PA

  • Optometrist
  • Eastover, NC
  • NPI 1659823813

  O20071210000071

  Same enrollment
• Professional Eyecare Optometry, PA

  • Optometrist
  • Hope Mills, NC
  • NPI 1811024961

  O20071210000071

  Same enrollment

Tax ID family

Professional Eyecare Optometry PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Eye Care Optometry, PA

  • Optometrist
  • Eastover, NC
  • NPI 1659823813
  NPD tax ID
• Professional Eyecare Optometry PA

  • Optometrist
  • Fayetteville, NC
  • NPI 1114050192
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary K Clark

  • Optometrist
  • Hope Mills, NC
  • NPI 1992449102
  NPD
• John Eric Raynor, OD

  • Optometrist
  • Hope Mills, NC
  • NPI 1972617272
  NPD (past)

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1053972877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 S MAIN ST",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283481958",
            "telephone_number": "910-423-0700",
            "fax_number": "910-423-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 W BROAD ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "28337",
            "telephone_number": "910-991-3003",
            "fax_number": "910-991-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL EYE CARE OPTOMETRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "ROSARIO-MCCULLOUGH",
        "authorized_official_first_name": "ENID",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "910-423-0700"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Pierce
• Positive Intervention Therapeutic Services Incorporated
• Troy Preacher, COTA
• Primary Health Choice, Inc.
• Primary Health Choice, Inc.
• Jacqueline Rapelye
• Rha Health Services NC, LLC
• Robert L Rich Jr., MD
• Bonnie Rochester, OT
• Crystal Michelle Rogers, DNP

• Optometrist in Elizabethtown, NC
• Providers in Elizabethtown, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; 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.