Roger D. Fannin, OD, PSC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1018DT Issued in KY

Legal business name

ROGER D. FANNIN, OD, PSC

Doing business as

Family Vision Health Center

Practice address

313 S Carol Malone Blvd
Grayson, KY 41143-1357

Phone

(606) 474-7833

Fax

(606) 474-3563

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Roger D. Fannin, ODNPI 1407857766

Title

President

Phone

(606) 474-7833

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Family Vision Health Center Doing business as

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

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

Practitioners 2

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

• Roger D. Fannin, O.D.

  • Optometrist
  • Grayson, KY
  • NPI 1407857766
  Medicare reassignment NPD Authorized official
• Joshua C Arnett, OD

  • Optometrist
  • Grayson, KY
  • NPI 1073351854
  Medicare reassignment NPD

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681430400000",
    "number": "1114128667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 S CAROL MALONE BLVD",
            "address_2": "PO BOX 485",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431357",
            "telephone_number": "606-474-7833",
            "fax_number": "606-474-3563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 S CAROL MALONE BLVD",
            "city": "GRAYSON",
            "state": "KY",
            "postal_code": "411431357",
            "telephone_number": "606-474-7833",
            "fax_number": "606-474-3563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER D. FANNIN, OD, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A",
        "authorized_official_last_name": "FANNIN",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-474-7833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1018DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77901023",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DA4435",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Vision Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Vision Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Grayson, KY
• Providers in Grayson, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; 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.