Individual provider Active NPI

Nikki Lynn Robertson, OD

  • Optometrist
  • Durham, NC
National Provider Identifier
1144410911
Registry record updated Mar 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2171 Issued in NC
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

Updated by the provider on Mar 29, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
5920321MedicaidNC
0931XOtherNCBCBS 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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

LicenseStateTypeSpecialty
00004135WAMDOptometrist
2171NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew 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

Verify at the official NPI Registry.