Active NPI
Seneca Decastro, OPTICIAN
- Optician
- Irmo, SC
National Provider Identifier
1346973609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1286
- Practice address
- Walmart Vision Center
1180 Dutch Fork Rd
Irmo, SC 29063 - Phone
- (803) 740-2635
- Fax
- (803) 781-6324
- NPI assigned
- Jul 5, 2022
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 1286 | SC | Primary |
Addresses
Primary practice location
Walmart Vision Center
1180 Dutch Fork Rd
Irmo, SC 29063
Mailing address
PO Box 892
Chapin, SC 29036-0892
Phone (727) 204-6791
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 |
|---|---|---|---|
| 1286 | SC | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1346973609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 892",
"city": "CHAPIN",
"state": "SC",
"postal_code": "290360892",
"telephone_number": "727-204-6791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WALMART VISION CENTER",
"address_2": "1180 DUTCH FORK RD",
"city": "IRMO",
"state": "SC",
"postal_code": "29063",
"telephone_number": "803-740-2635",
"fax_number": "803-781-6324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECASTRO",
"first_name": "SENECA",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-05",
"last_updated": "2022-07-05",
"certification_date": "2022-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "SC",
"license": "1286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irmo, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.