Distinctive Eyewear Vision Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

1396 Issued in SC

Legal business name

DISTINCTIVE EYEWEAR VISION CENTER

Practice address

1206 Moser Dr
The Market Common
Myrtle Beach, SC 29577-1575

Phone

(843) 213-1201

NPI assigned

Sep 27, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Lauri Baldwin Graham, O.D.NPI 1730240151

Title

Owner

Phone

(843) 213-1201

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

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.

• Lauri B. Graham, O.D.

  • Optometrist
  • Myrtle Beach, SC
  • NPI 1730240151
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317081600000",
    "number": "1174806053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 MOSER DR",
            "address_2": "THE MARKET COMMON",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295771575",
            "telephone_number": "843-213-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 MOSER DR",
            "address_2": "THE MARKET COMMON",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295771575",
            "telephone_number": "843-213-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTINCTIVE EYEWEAR VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-27",
        "last_updated": "2011-09-27",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "LAURI",
        "authorized_official_middle_name": "BALDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-213-1201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Dillon, DR
• Tara-Marie Dinitto, MD
• Katelyn Dinkowitz
• Tiffany Dipaola, PHARMD
• Patrick Anthony Disarno, RPH
• Gabrielle Diulio, DPT
• DME Hearing Center, Inc. (Miracle Ear Center)
• Michele Doan
• Katherine Dobis
• Doctor Fitness , Inc

• Optometrist in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; 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.