Advanced Eyecare, LLC
Organization Active NPI Optometrist · Picayune, MS
NPI 1104045665 · NPPES record last updated Dec 13, 2017
Key facts
- NPI
- 1104045665
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 611 (MS)
- Legal business name
- ADVANCED EYECARE, LLC
- Practice address
- 5 Alex PL
Picayune, MS 39466-9697 - Phone
- (601) 799-0707
- Fax
- (601) 799-0700
- NPI assigned
- Apr 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kraig Micheal Stasney, O.D.
- Title
- Optometrist
- Phone
- (601) 799-0707
Practitioners 7
-
Kraig Michael Stasney, O.D.
-
Jarrad Berry, O.D.
-
Duyen K Le, O.D.
-
Danielle Stasney, O.D.
-
Gary M Artigue, O.D.
-
Anh V Ta, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2161670 | Advanced Eyecare, LLC | Certificate of waiver | Feb 6, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Advanced Eyecare, LLC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MS, LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060127000494 | MS | Part B Supplier - Clinic/Group Practice | 1254345366 |
Receives reassigned benefits from 5 practitioners Practice locations: Picayune, MS |
| O20100930071286 | MS | DME Supplier - Physician - Optometrist | 1254345366 | Practice locations: Picayune, MS |
| O20141205001697 | LA | Part B Supplier - Clinic/Group Practice | 1254345366 |
Receives reassigned benefits from 6 practitioners Practice locations: Pearl River, LA |
National Provider Directory
Locations
64185 Highway 41
Ste B
Pearl River, LA 70452
Phone (985) 250-8000
64185 Highway 41
Pearl River, LA 70452
5 Alex Pl
Picayune, MS 39466
Phone (601) 799-0707
718 Highway 11 S
#B
Picayune, MS 39466
Phone (601) 799-0707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 611 | MS | Yes |
Addresses
Primary practice location
5 Alex PL
Picayune, MS 39466-9697
Mailing address
5 Alex PL
Picayune, MS 39466-9697
Phone (601) 799-0707
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05152521 | Medicaid | MS |
Other providers in Picayune, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.