NPIMap

Organization Active NPI

Carolina Glaucoma PA

  • Ophthalmology Physician
  • Wilmington, NC
National Provider Identifier
1174797666
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
9700718 Issued in NC
Legal business name
CAROLINA GLAUCOMA PA
Practice address
1907 S 17TH St Ste 3
Wilmington, NC 28401-6656
Phone
(910) 341-0011
Fax
(910) 341-0012
NPI assigned
Apr 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Mary Elizabeth Price, M.D.NPI 1821107772
Title
President
Phone
(910) 341-0011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 9700718 NC Primary

Addresses

Primary practice location

1907 S 17TH St Ste 3
Wilmington, NC 28401-6656

Mailing address

1907 S 17TH Street
Suite 3
Wilmington, NC 28401
Phone (910) 341-0011

Other practice location 1

14 Doctors Circle
Suite 1
Supply, NC 28462-4088
Phone (910) 341-0011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080602000795 NC Part B Supplier - Clinic/Group Practice 0648340794 Receives reassigned benefits from 1 practitioner
Practice locations: Supply, NC; Wilmington, NC

National Provider Directory

National Provider Directory
Tax ID family
Carolina Glaucoma2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14 Doctors Cir
Ste 1
Supply, NC 28462
Phone (910) 256-4899

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1174797666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 S 17TH STREET",
            "address_2": "SUITE 3",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28401",
            "telephone_number": "910-341-0011",
            "fax_number": "910-341-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 S 17TH ST STE 3",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016656",
            "telephone_number": "910-341-0011",
            "fax_number": "910-341-0012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Doctors Circle",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Supply",
            "state": "NC",
            "postal_code": "284624088",
            "country_code": "US",
            "telephone_number": "910-341-0011",
            "fax_number": "910-341-0012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAROLINA GLAUCOMA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-341-0011",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "NC",
            "license": "9700718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.