Angelo Joseph Devivo, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2117 Issued in SC

Practice address

1774 Paxville Hwy
Manning, SC 29102-5071

Phone

(803) 435-2494

Fax

(803) 435-8765

NPI assigned

Jun 1, 2005

Last updated

Dec 14, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myeyedr Optometry of South Carolina, LLCGroup PAC ID 3173741618, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://fhir4.healow.com/fhir/r4/BFEFCD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Myeyedr Optometry of South Carolina, LLC

  dba MyEyeDr

  • Optometrist
  • Rock Hill, SC
  • NPI 1205248481
  Medicare reassignment Care Compare group NPD
• Family Health Centers, Inc

  dba Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Orangeburg, SC
  • NPI 1144248451
  NPD
• Myeyedr Optometry of South Carolina, LLC

  • Optometrist
  • Indian Land, SC
  • NPI 1093679961
  NPD
• Myeyedr Optometry of South Carolina, LLC

  dba MyEyeDr.

  • Optometrist
  • Charleston, SC
  • NPI 1518636125
  NPD
• Ophthalmic Physicians Inc

  • Ophthalmology Physician
  • Ashtabula, OH
  • NPI 1104083336
  NPD (past)
• Retina Associates of Cleveland, Inc.

  • Retina Specialist (Ophthalmology) Physician
  • Beachwood, OH
  • NPI 1912991225
  NPD (past)

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1326040536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1774 PAXVILLE HWY",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291025071",
            "telephone_number": "803-435-2494",
            "fax_number": "803-435-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVIVO",
        "first_name": "ANGELO",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "2117",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4531 T1261",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D21171",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jagat Chand Daliya, MD
• Amani Davies
• Lakin Leeann Davis, PHARMD
• Dental Wellness Center Eb5 VI LLC (Angel Dental Manning)
• Dental Wellness Center of Manning, LLC
• Diamond Medical Supply, LLC (Tony Junious)
• Lashonda Michelle Dingle, FNP
• Gaye Moore Douglas, FNP
• Cherry A Dow
• Jessica Duke, LMSW

• Optometrist in Manning, SC
• Providers in Manning, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.