Organization Active NPI

Optix Eyecare Center OD PLLC

  • Optometrist
  • Durham, NC
National Provider Identifier
1073621330
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTIX EYECARE CENTER OD PLLC
Practice address
2812 Erwin Rd
Ste 201
Durham, NC 27705
Phone
(919) 384-0784
Fax
(919) 321-6249
NPI assigned
Aug 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mark Stuart Newman, ODNPI 1154309060
Title
Owner
Phone
(919) 384-0784

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 Primary

Addresses

Primary practice location

2812 Erwin Rd
Ste 201
Durham, NC 27705

Mailing address

2812 Erwin Rd
Ste 201
Durham, NC 27705
Phone (919) 384-0784

Other identifiers 2

IdentifierTypeStateIssuer
09501OtherBCBS NC
8909501MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060106000259 NC Part B Supplier - Clinic/Group Practice 1355364282 Receives reassigned benefits from 1 practitioner
Practice locations: Durham, 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
34D2096227Optix Eyecare Center, OD, PLLC2812 Erwin Road, Suite 201, Durham, NC 27705Certificate of waiverMay 18, 2027

National Provider Directory

National Provider Directory

Locations

2812 Erwin Rd
Ste 201
Durham, NC 27705
Phone (919) 384-0784

Practitioners & affiliated clinicians

Practitioners 1

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": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073621330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2812 ERWIN RD",
            "address_2": "STE 201",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27705",
            "telephone_number": "919-384-0784",
            "fax_number": "919-321-6249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 ERWIN RD",
            "address_2": "STE 201",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27705",
            "telephone_number": "919-384-0784",
            "fax_number": "919-321-6249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIX EYECARE CENTER OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-384-0784",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "09501",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909501",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.