NPIMap

Organization Active NPI

Canton Vision Clinic, P.a.

  • Optometrist
  • Canton, MS
National Provider Identifier
1174607477
Registry record updated Sep 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CANTON VISION CLINIC, P.A.
Practice address
1185 Hart St
Canton, MS 39046-4805
Phone
(601) 859-3464
Fax
(601) 859-9003
NPI assigned
Oct 24, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. James W Bearden III, ODNPI 1831405448
Title
Owner
Phone
(601) 859-3464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2000811Canton Vision Clinic PA1185 Hart Street, Canton, MS 39046Certificate of waiverDec 6, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Canton Vision Clinic PA1185 Hart St, Canton, MS 39046-4805(601) 859-3464 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since May 10, 2006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061107000311 MS Part B Supplier - Clinic/Group Practice 5799782629 Receives reassigned benefits from 10 practitioners
Practice locations: Canton, MS
O20100930049744 MS DME Supplier - Physician - OptometristDME Supplier - Optician 5799782629 Practice locations: Canton, MS

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X MS Primary

Addresses

NPPES NPI Registry

Primary practice location

1185 Hart St
Canton, MS 39046-4805

Mailing address

1185 Hart St
Canton, MS 39046-4805
Phone (601) 859-3464

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
03380062MedicaidMS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 16, 2014.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1174607477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 HART ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390464805",
            "telephone_number": "601-859-3464",
            "fax_number": "601-859-9003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 HART ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390464805",
            "telephone_number": "601-859-3464",
            "fax_number": "601-859-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON VISION CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "BEARDEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-859-3464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03380062",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; 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.