NPIMap

Organization Active NPI

Hillcrest Vision, O.D., P.a.

  • Optometrist
  • Winston Salem, NC
National Provider Identifier
1104071695
Registry record updated Jul 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2000 Issued in NC
Legal business name
HILLCREST VISION, O.D., P.A.
Practice address
2341 Winterhaven LN
Winston Salem, NC 27103-6792
Phone
(336) 760-2020
Fax
(336) 760-2858
NPI assigned
Nov 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2013

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

Authorized official

Name
Dr. Juawana Coleman Hall, O.D.NPI 1659359537
Title
President
Phone
(336) 760-2020

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 2000 NC Primary

Addresses

Primary practice location

2341 Winterhaven LN
Winston Salem, NC 27103-6792

Mailing address

2341 Winterhaven LN
Winston Salem, NC 27103-6792
Phone (336) 760-2020

Other identifiers 1

IdentifierTypeStateIssuer
5902677MedicaidNC

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090305000729 NC Part B Supplier - Clinic/Group Practice 5395800411 Receives reassigned benefits from 4 practitioners
Practice locations: Winston-Salem, NC
O20100930041747 NC DME Supplier - Physician - Optometrist 5395800411 Practice locations: Winston Salem, 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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Hillcrest Vision2341 Winterhaven LN, Winston Salem, NC 27103-6792(336) 760-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Dec 6, 2008

National Provider Directory

National Provider Directory

Locations

2341 Winterhaven Ln
Winston Salem, NC 27103
Phone (336) 760-2020

Practitioners & affiliated clinicians

Practitioners 6

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": "1227571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374105600000",
    "number": "1104071695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2341 WINTERHAVEN LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036792",
            "telephone_number": "336-760-2020",
            "fax_number": "336-760-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 WINTERHAVEN LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036792",
            "telephone_number": "336-760-2020",
            "fax_number": "336-760-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLCREST VISION, O.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-25",
        "last_updated": "2013-07-18",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "JUAWANA",
        "authorized_official_middle_name": "COLEMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-760-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902677",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; 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.