NPIMap

Organization Active NPI

Carolina Vision Associates, LLC

  • Optometrist
  • Woodruff, SC
National Provider Identifier
1134448806
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1092 Issued in SC
Legal business name
CAROLINA VISION ASSOCIATES, LLC
Practice address
363 E. Georgia St
Woodruff, SC 29388
Phone
(864) 476-8322
Fax
(864) 476-0752
NPI assigned
May 20, 2010
Last updated
Apr 11, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CAROLINA VISION ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Authorized official

Name
Kimberly Willard
Title
Practice Administrator
Phone
(864) 583-3125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1092 SC Primary

Addresses

Primary practice location

363 E. Georgia St
Woodruff, SC 29388

Mailing address

180 N. Dean Street
Spartanburg, SC 29302
Phone (864) 583-3125

Other identifiers 1

IdentifierTypeStateIssuer
DA9837MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120723000728 SC DME Supplier - Physician - Optometrist 5799683959 Practice locations: Woodruff, SC

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Carolina Vision Associates LLC363 E Georgia St, Woodruff, SC 29388-1913(864) 476-0752 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Sep 23, 1997

National Provider Directory

National Provider Directory
Tax ID family
Carolina Vision Assoc G5 organizations share this tax ID, including this one
Part of
Carolina Vision Assoc G

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

363 E Georgia St
Woodruff, SC 29388
Phone (864) 476-0990

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1134448806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 N. DEAN STREET",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "29302",
            "telephone_number": "864-583-3125",
            "fax_number": "864-542-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 E. GEORGIA ST",
            "city": "WOODRUFF",
            "state": "SC",
            "postal_code": "29388",
            "telephone_number": "864-476-8322",
            "fax_number": "864-476-0752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA VISION ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAROLINA VISION ASSOCIATES, LLC",
        "enumeration_date": "2010-05-20",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "WILLARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "864-583-3125"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9837",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodruff, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.