Optical Illusions, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT0001798 Issued in GA

Legal business name

OPTICAL ILLUSIONS, PC

Doing business as

Vision Source Partners

Practice address

775 C Kingsbay Road
St Marys, GA 31558

Phone

(912) 729-6111

Fax

(912) 729-8595

NPI assigned

Jan 10, 2007

Last updated

Nov 6, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ian Buchli, O.D.NPI 1003875386

Title

Ceo

Phone

(912) 729-6111

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vision Source Partners Doing business as

Tax ID family

Optical Illusions PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Optical Illusions, P.C.

  dba Vision Source Family Eye Care

  • Optometrist
  • Brunswick, GA
  • NPI 1669521886
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ian Buchli, O.D.

  • Optometrist
  • Brunswick, GA
  • NPI 1003875386
  NPD Authorized official
• Andrew Glen Knezich, OD

  • Optometrist
  • Brunswick, GA
  • NPI 1578546214
  NPD (past)
• Gerald W. Koss II, O.D.

  • Optometrist
  • Brunswick, GA
  • NPI 1528145257
  NPD (past)
• Scott A. Trefts, O.D.

  • Optometrist
  • St Simons Is, GA
  • NPI 1740315936
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1346390895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 C KINGSBAY ROAD",
            "city": "ST MARYS",
            "state": "GA",
            "postal_code": "31558",
            "telephone_number": "912-729-6111",
            "fax_number": "912-729-8595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 C KINGSBAY ROAD",
            "city": "ST MARYS",
            "state": "GA",
            "postal_code": "31558",
            "telephone_number": "912-729-6111",
            "fax_number": "912-729-8595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL ILLUSIONS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "BUCHLI",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-729-6111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT0001798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000954291A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Annette Nixon, RN
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• Philip Matthew Oconnell, MD
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• Sean Christopher Orr, M.D.
• P L Hooton DMD PC (Camden Dental Care)
• Lauren J Panzarella, D.C.
• Livio Federico Pardi, MD
• Jennifer Parham, RN

• Optometrist in Saint Marys, GA
• Providers in Saint Marys, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; 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.