Active NPI
Nikki Lynn Robertson, OD
- Optometrist
- Durham, NC
National Provider Identifier
1144410911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2171
- Practice address
- 3101 Shannon Rd
Durham, NC 27707-3571 - Phone
- (919) 493-8508
- Fax
- (919) 676-2231
- NPI assigned
- Jul 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 00004135 | WA | |
| Optometrist | 152W00000X | 2171 | NC | Primary |
Addresses
Primary practice location
3101 Shannon Rd
Durham, NC 27707-3571
Mailing address
7100 Six Forks Rd
Suite 301
Raleigh, NC 27615-6156
Phone (919) 847-0187
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5920321 | Medicaid | NC | |
| 0931X | Other | NC | BCBS NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100415000242 | NC | Practitioner - Optometry | 9537244470 |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 2007
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
211 Friday Ctr Dr
Suite 2057
Chapel Hill, NC 27517
3509 Haworth Dr
Suite 208
Raleigh, NC 27609-7223
3509 Haworth Dr
Suite 208
Raleigh, NC 27660-7223
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00004135 | WA | MD | Optometrist |
| 2171 | NC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyeco Optometry PS | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364515200000",
"number": "1144410911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7100 SIX FORKS RD",
"address_2": "SUITE 301",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276156156",
"telephone_number": "919-847-0187",
"fax_number": "919-676-2231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3101 SHANNON RD",
"city": "DURHAM",
"state": "NC",
"postal_code": "277073571",
"telephone_number": "919-493-8508",
"fax_number": "919-676-2231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "NIKKI",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-27",
"last_updated": "2013-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "00004135",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "2171",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5920321",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "0931X",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.