NPIMap

Organization Active NPI

Carolina Vision Associates, LLC

  • Optometrist
  • Spartanburg, SC
National Provider Identifier
1255357356
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
654 Issued in SC
Legal business name
CAROLINA VISION ASSOCIATES, LLC
Practice address
180 N. Dean Street
Spartanburg, SC 29302-1517
Phone
(864) 583-3125
Fax
(864) 542-1367
NPI assigned
Jul 14, 2006
Last updated
Apr 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Authorized official

Name
Ms. Kimberly Willard
Title
Practice Administrator
Phone
(864) 583-3125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 654 SC Primary

Addresses

Primary practice location

180 N. Dean Street
Spartanburg, SC 29302-1517

Mailing address

180 N. Dean Street
Spartanburg, SC 29302-1517
Phone (864) 583-3125

Other identifiers 11

IdentifierTypeStateIssuer
DA9837MedicaidSC
D10924MedicaidSC
DO6544MedicaidSC
D10502MedicaidSC
CJ9701OtherSCRAILROAD MEDICARE GROUP #
D10664MedicaidSC
DA9716MedicaidSC
DA9717MedicaidSC
D10496MedicaidSC
DA9715MedicaidSC
DO9621MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031224000032 SC Part B Supplier - Clinic/Group Practice 5799683959 Receives reassigned benefits from 7 practitioners
Practice locations: Gaffney, SC
O20100930008808 SC DME Supplier - Physician - OptometristDME Supplier - Optician 5799683959 Practice locations: Spartanburg, SC

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Carolina Vision Assoc G5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

43 N Main St
Inman, SC 29349
Phone (864) 472-2144

180 N Dean St
Spartanburg, SC 29302
Phone (864) 583-3125

180 N Dean St
Ste 101
Spartanburg, SC 29302
Phone (864) 583-3125

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1255357356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 N. DEAN STREET",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293021517",
            "telephone_number": "864-583-3125",
            "fax_number": "864-542-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 N. DEAN STREET",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293021517",
            "telephone_number": "864-583-3125",
            "fax_number": "864-542-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA VISION ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "WILLARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "864-583-3125",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9837",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D10924",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DO6544",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D10502",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CJ9701",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D10664",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9716",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9717",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D10496",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9715",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DO9621",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; 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.