Active NPI
Timothy A Stafford, O.D.
- Optometrist
- Newberry, SC
National Provider Identifier
1306805692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 696
- Practice address
- 2737 Winnsboro Rd
Newberry, SC 29108-4011 - Phone
- (803) 276-3271
- Fax
- (803) 233-2881
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 696 | SC | Primary |
Addresses
Primary practice location
2737 Winnsboro Rd
Newberry, SC 29108-4011
Mailing address
2737 Winnsboro Rd
PO Box 493
Newberry, SC 29108-4011
Phone (803) 276-3271
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D06964 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111206000281 | SC | Practitioner - Optometry | 6103940473 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 696 | SC | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| F Mason Smith | Optometrist | Past | Accepting new patients |
| Shoes Etc LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Mt Pleasant, SC
- NPI 1477795722
-
- Durable Medical Equipment & Medical Supplies
- Columbia, SC
- NPI 1144205766
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371686400000",
"number": "1306805692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2737 WINNSBORO RD",
"address_2": "PO BOX 493",
"city": "NEWBERRY",
"state": "SC",
"postal_code": "291084011",
"telephone_number": "803-276-3271",
"fax_number": "803-233-2881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2737 WINNSBORO RD",
"city": "NEWBERRY",
"state": "SC",
"postal_code": "291084011",
"telephone_number": "803-276-3271",
"fax_number": "803-233-2881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "TIMOTHY",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2013-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "SC",
"license": "696",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D06964",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newberry, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.