NPIMap

Organization Active NPI

Nationwide Vision Center, LLC

  • Optician
  • Mesa, AZ
National Provider Identifier
1205995388
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
NATIONWIDE VISION CENTER, LLC
Practice address
955 W Southern Ave Ste 101
Mesa, AZ 85210-4903
Phone
(480) 961-1865
Fax
(480) 893-8172
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

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

Authorized official

Name
Joseph Pravoot Gira, MD
Title
Chief Medical Officer
Phone
(314) 909-0633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 156FX1800X Primary

Addresses

Primary practice location

955 W Southern Ave Ste 101
Mesa, AZ 85210-4903

Mailing address

955 W Southern Ave Ste 101
Mesa, AZ 85210-4903
Phone (480) 961-1865

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031126000599 AZ Part B Supplier - Clinic/Group Practice 7810892205 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Nationwide Vision Cente18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 4

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": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687478400000",
    "number": "1205995388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 W SOUTHERN AVE STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104903",
            "telephone_number": "480-961-1865",
            "fax_number": "480-961-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W SOUTHERN AVE STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104903",
            "telephone_number": "480-961-1865",
            "fax_number": "480-893-8172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONWIDE VISION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A",
        "authorized_official_last_name": "GIRA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "PRAVOOT",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "314-909-0633",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; 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.