Active NPI
Wilbur Carlyle Ardis III
- Optician
- Sumter, SC
National Provider Identifier
1144600107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1074
- Practice address
- 2118 Gin Branch Rd
Sumter, SC 29154-7203 - Phone
- (803) 450-0384
- NPI assigned
- Jun 4, 2015
- Last updated
- Jun 4, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 1074 | SC | Primary |
Addresses
Primary practice location
2118 Gin Branch Rd
Sumter, SC 29154-7203
Mailing address
2118 Gin Branch Rd.
Sumter, SC 29154
Phone (803) 450-0384
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1074 | SC | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433376000000",
"number": "1144600107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2118 GIN BRANCH RD.",
"city": "SUMTER",
"state": "SC",
"postal_code": "29154",
"telephone_number": "803-450-0384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2118 GIN BRANCH RD",
"city": "SUMTER",
"state": "SC",
"postal_code": "291547203",
"telephone_number": "803-450-0384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARDIS",
"first_name": "WILBUR",
"middle_name": "CARLYLE",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-04",
"last_updated": "2015-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "SC",
"license": "1074",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sumter, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.