NPIMap

Organization Active NPI

Pro Vision Optometric Center PA

  • Optometrist
  • Roanoke Rapids, NC
National Provider Identifier
1285767814
Registry record updated Jan 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1506 Issued in NC
Legal business name
PRO VISION OPTOMETRIC CENTER PA
Practice address
12 Anna Louise LN
Roanoke Rapids, NC 27870-8648
Phone
(252) 519-9401
Fax
(252) 519-9404
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2009

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

Authorized official

Name
Dr. Diana Pesteanu, O.D.
Title
Owner
Phone
(252) 519-9401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1506 NC Primary

Addresses

Primary practice location

12 Anna Louise LN
Roanoke Rapids, NC 27870-8648

Mailing address

12 Anna Louise LN
Roanoke Rapids, NC 27870-8648
Phone (252) 519-9401

Other identifiers 2

IdentifierTypeStateIssuer
890243LMedicaidNC
890928EMedicaidNC

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231891200000",
    "number": "1285767814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 ANNA LOUISE LN",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278708648",
            "telephone_number": "252-519-9401",
            "fax_number": "252-519-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ANNA LOUISE LN",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278708648",
            "telephone_number": "252-519-9401",
            "fax_number": "252-519-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO VISION OPTOMETRIC CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2009-01-14",
        "status": "A",
        "authorized_official_last_name": "PESTEANU",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-519-9401",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890243L",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890928E",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke Rapids, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; 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.