Active NPI
Vivencio Crisostomo Austero Jr., LDO, ABOC
- Optician
- Matthews, NC
National Provider Identifier
1336667153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1050
- Practice address
- 3800 Pleasant Plains Rd
Matthews, NC 28104-5958 - Phone
- (704) 401-4793
- Fax
- (704) 821-1363
- NPI assigned
- Aug 31, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 1050 | NC | Primary |
Addresses
Primary practice location
3800 Pleasant Plains Rd
Matthews, NC 28104-5958
Mailing address
3800 Pleasant Plains Rd
Matthews, NC 28104-5958
Phone (704) 401-4793
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1050 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1336667153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 PLEASANT PLAINS RD",
"city": "MATTHEWS",
"state": "NC",
"postal_code": "281045958",
"telephone_number": "704-401-4793",
"fax_number": "704-821-1363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 PLEASANT PLAINS RD",
"city": "MATTHEWS",
"state": "NC",
"postal_code": "281045958",
"telephone_number": "704-401-4793",
"fax_number": "704-821-1363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUSTERO",
"first_name": "VIVENCIO",
"middle_name": "CRISOSTOMO",
"name_suffix": "Jr.",
"credential": "LDO, ABOC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-31",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NC",
"license": "1050",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Matthews, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.