NPIMap

Organization Active NPI

Rufus B. Antley, OD

Doing business as Wagener Vision Clinic

  • Optometrist
  • Wagener, SC
National Provider Identifier
1124103536
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
433 Issued in SC
Legal business name
RUFUS B. ANTLEY, OD
Doing business as
Wagener Vision Clinic
Practice address
149 N. Main St
Wagener, SC 29164
Phone
(803) 564-6728
Fax
(803) 564-6750
NPI assigned
Oct 25, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mrs. Barbara L. Antley
Title
Office Manager
Phone
(803) 532-9870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 433 SC Primary

Addresses

Primary practice location

149 N. Main St
Wagener, SC 29164

Mailing address

PO Box 130
Wagener, SC 29164
Phone (803) 564-6728

Other identifiers 1

IdentifierTypeStateIssuer
DA9844MedicaidSC

Other names 1

  • Wagener Vision Clinic Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1124103536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "WAGENER",
            "state": "SC",
            "postal_code": "29164",
            "telephone_number": "803-564-6728",
            "fax_number": "803-564-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 N. MAIN ST",
            "city": "WAGENER",
            "state": "SC",
            "postal_code": "29164",
            "telephone_number": "803-564-6728",
            "fax_number": "803-564-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUFUS B. ANTLEY, OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ANTLEY",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-532-9870",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9844",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagener Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wagener, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.