NPIMap

Organization Active NPI

Kerry P Sullivan OD

  • Optometrist
  • Windsor, NC
National Provider Identifier
1316104243
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1268 Issued in NC
Legal business name
KERRY P SULLIVAN OD
Practice address
106 N King St
Windsor, NC 27983-6863
Phone
(252) 794-3381
NPI assigned
May 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Authorized official

Name
Kerry P Sullivan, ODNPI 1326154477
Title
Optometrist
Phone
(252) 794-3381

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 1268 NC Primary

Addresses

Primary practice location

106 N King St
Windsor, NC 27983-6863

Mailing address

PO Box 160
Windsor, NC 27983-0160
Phone (252) 794-3381

Other identifiers 1

IdentifierTypeStateIssuer
890979EMedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1316104243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279830160",
            "telephone_number": "252-794-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N KING ST",
            "city": "WINDSOR",
            "state": "NC",
            "postal_code": "279836863",
            "telephone_number": "252-794-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY P SULLIVAN OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "252-794-3381",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890979E",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.