Active NPI
Charles M Wormington III, OPTOMETRIST
- Optometrist
- Philadelphia, PA
National Provider Identifier
1205846110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OEG000102
- Practice address
- 1200 W Godfrey Ave
Philadelphia, PA 19141-3323 - Phone
- (215) 276-6000
- Fax
- (215) 276-1329
- NPI assigned
- Aug 9, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OEG000102 | PA | Primary |
Addresses
Primary practice location
1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Mailing address
1575 Elkins Ave
Abington, PA 19001-1915
Phone (215) 576-8409
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56264 | Other | PA | BLUE SHIELD |
| 2248 | Other | PA | AETNA HMO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OEG000102 | PA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205846110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1575 ELKINS AVE",
"city": "ABINGTON",
"state": "PA",
"postal_code": "190011915",
"telephone_number": "215-576-8409",
"fax_number": "215-276-1329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 W GODFREY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191413323",
"telephone_number": "215-276-6000",
"fax_number": "215-276-1329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORMINGTON",
"first_name": "CHARLES",
"middle_name": "M",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "OPTOMETRIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "OEG000102",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "56264",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "2248",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.