NPIMap

Organization Active NPI

Draisin Vision Group PA

  • Optometrist
  • Charleston, SC
National Provider Identifier
1174726210
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
503 Issued in SC
Legal business name
DRAISIN VISION GROUP PA
Practice address
1470 Tobias Gadson Blvd
Suite 115
Charleston, SC 29407-4707
Phone
(843) 556-2020
Fax
(843) 763-3937
NPI assigned
Jun 7, 2007
Last updated
Nov 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Authorized official

Name
Bridget Kelly Bessinger
Title
Admin Assist
Phone
(843) 556-2020

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 503 SC Primary
Optometrist 152W00000X 1413 SC
Corneal and Contact Management Optometrist 152WC0802X 503 SC
Corneal and Contact Management Optometrist 152WC0802X 1413 SC
Low Vision Rehabilitation Optometrist 152WL0500X 1413 SC
Sports Vision Optometrist 152WS0006X 503 SC
Vision Therapy Optometrist 152WV0400X 503 SC

Addresses

Primary practice location

1470 Tobias Gadson Blvd
Suite 115
Charleston, SC 29407-4707

Mailing address

PO Box 80817
Charleston, SC 29416-0817
Phone (843) 556-2020

Other identifiers 3

IdentifierTypeStateIssuer
1548226822OtherSCNDRAISIN NPI #
1730305434OtherSCJ SMITH'S NPI #
D05037MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080225000463 SC Part B Supplier - Clinic/Group Practice 8123102563 Receives reassigned benefits from 7 practitioners
Practice locations: Charleston, SC

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
42D2012820The Draisin Vision Group1470 Tobias Gadson Blvd, Ste 115, Charleston, SC 29407Certificate of waiverSep 8, 2026

National Provider Directory

National Provider Directory

Locations

1470 Tobias Gadson Blvd
Ste 115
Charleston, SC 29407
Phone (843) 556-2020

Practitioners & affiliated clinicians

Practitioners 12

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": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1174726210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80817",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294160817",
            "telephone_number": "843-556-2020",
            "fax_number": "843-763-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1470 TOBIAS GADSON BLVD",
            "address_2": "SUITE 115",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074707",
            "telephone_number": "843-556-2020",
            "fax_number": "843-763-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRAISIN VISION GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "BESSINGER",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "KELLY",
        "authorized_official_title_or_position": "ADMIN ASSIST",
        "authorized_official_telephone_number": "843-556-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "503",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1413",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "SC",
            "license": "503",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "SC",
            "license": "1413",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "SC",
            "license": "1413",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "SC",
            "license": "503",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "SC",
            "license": "503",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDRAISIN  NPI #",
            "identifier": "1548226822",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "J SMITH'S  NPI #",
            "identifier": "1730305434",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D05037",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; 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.