Active NPI
Laura Marie Suppa Sammons, OD
- Optometrist
- Charleston, WV
National Provider Identifier
1235571563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2002-IOD1
- Practice address
- 4202 Maccorkle Ave SE
Charleston, WV 25304-2502 - Phone
- (304) 925-4761
- Fax
- (304) 925-0310
- NPI assigned
- Jul 29, 2013
- Last updated
- Jan 12, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 2002-IOD1 | WV | Primary |
Addresses
Primary practice location
4202 Maccorkle Ave SE
Charleston, WV 25304-2502
Mailing address
4202 Maccorkle Ave SE
Charleston, WV 25304-2502
Phone (304) 925-4761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4202 Maccorkle Ave SE
Charleston, WV 25304-2502
Phone (304) 925-4761
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 12 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002-IOD1 | WV | MD | Optometrist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641945600000",
"number": "1235571563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4202 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042502",
"telephone_number": "304-925-4761",
"fax_number": "304-925-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4202 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042502",
"telephone_number": "304-925-4761",
"fax_number": "304-925-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPPA SAMMONS",
"first_name": "LAURA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-29",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WV",
"license": "2002-IOD1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.