South Eastern Eye Center, Office of Dr Nacondus Gamble

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002433 Issued in GA

Legal business name

SOUTH EASTERN EYE CENTER, OFFICE OF DR NACONDUS GAMBLE

Practice address

345 Lindquist
BLDG. 71
Apo, AA 31314-0345

Phone

(912) 876-1101

Fax

(912) 877-4244

NPI assigned

Jan 29, 2009

Last updated

May 17, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nacondus Grayson Gamble, O.D., F.A.A.ONPI 1861402588

Title

Owner

Phone

(912) 876-1101

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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.

• Nacondus G Gamble, OPTOMETRIST

  • Optometrist
  • Fort Stewart, GA
  • NPI 1861402588
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1233187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1093953002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3700",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313153700",
            "telephone_number": "912-748-3926",
            "fax_number": "912-877-4244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "345 LINDQUIST",
            "address_2": "BLDG. 71",
            "city": "APO",
            "state": "AA",
            "postal_code": "313140345",
            "telephone_number": "912-876-1101",
            "fax_number": "912-877-4244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH EASTERN EYE CENTER, OFFICE OF DR NACONDUS GAMBLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-29",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "NACONDUS",
        "authorized_official_middle_name": "GRAYSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-876-1101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D., F.A.A.O"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; 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.