Alvernon Optical, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

813 Issued in AZ

Legal business name

ALVERNON OPTICAL, INC.

Practice address

101 S la Canada Dr Ste 69
Green Valley, AZ 85614-2665

Phone

(520) 625-5657

Fax

(520) 625-5659

NPI assigned

Mar 23, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stacia A Decker, LDO

Title

VP of Retail

Phone

(520) 327-6215

Specialties & licenses 1

Addresses

Other identifiers 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.

• Kenneth W Welsh, OD

  • Optometrist
  • Green Valley, AZ
  • NPI 1184735672
  NPD (past)

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194842591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S LA CANADA DR STE 69",
            "city": "GREEN VALLEY",
            "state": "AZ",
            "postal_code": "856142665",
            "telephone_number": "520-625-5657",
            "fax_number": "520-625-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S LA CANADA DR STE 69",
            "city": "GREEN VALLEY",
            "state": "AZ",
            "postal_code": "856142665",
            "telephone_number": "520-625-5657",
            "fax_number": "520-625-5659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALVERNON OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DECKER",
        "authorized_official_first_name": "STACIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP OF RETAIL",
        "authorized_official_telephone_number": "520-327-6215",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "AZ",
            "license": "813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405218",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Green Valley, AZ
• Providers in Green Valley, AZ by specialty
• Eyewear Supplier in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.