NPIMap

Organization Active NPI

Avondale Eye Care

  • Optometrist
  • Charleston, SC
National Provider Identifier
1285807131
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
SC 1374 Issued in SC
Legal business name
AVONDALE EYE CARE
Practice address
1251 Savannah Hwy
Charleston, SC 29407-7826
Phone
(843) 870-4073
NPI assigned
Apr 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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

Authorized official

Name
Joseph M Pitcavage, ODNPI 1336167279
Title
President
Phone
(843) 870-4073

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X SC 1374 SC Primary

Addresses

Primary practice location

1251 Savannah Hwy
Charleston, SC 29407-7826

Mailing address

1251 Savannah Hwy
Charleston, SC 29407-7826
Phone (843) 870-4073

Other identifiers 1

IdentifierTypeStateIssuer
DA9650MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080813000904 SC Part B Supplier - Clinic/Group Practice 8527133370 Receives reassigned benefits from 11 practitioners
Practice locations: Charleston, SC

National Provider Directory

National Provider Directory

Locations

12 Farmfield Ave
Ste C
Charleston, SC 29407
Phone (843) 763-2270

1718 State Rd
Ste 8D
Summerville, SC 29486
Phone (843) 900-4050

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1285807131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 SAVANNAH HWY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077826",
            "telephone_number": "843-870-4073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 SAVANNAH HWY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077826",
            "telephone_number": "843-870-4073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVONDALE EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-10",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "PITCAVAGE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-870-4073",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "SC 1374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9650",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; 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.