Advantage Vision Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

1087 Issued in NC

Legal business name

ADVANTAGE VISION CENTER

Practice address

1016 S Church St
Charlotte, NC 28203-4002

Phone

(704) 375-3935

Fax

(704) 333-7238

NPI assigned

Oct 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Paula Renee Newsome, ODNPI 1225039993

Title

Ceo

Phone

(704) 375-3935

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

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

• Paula Renee Newsome, OD, MS, FAAO

  • Optometrist
  • Charlotte, NC
  • NPI 1225039993

  NC

  Medicare reassignment Authorized official

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1366524910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 S CHURCH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282034002",
            "telephone_number": "704-375-3935",
            "fax_number": "704-333-7238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 S CHURCH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282034002",
            "telephone_number": "704-375-3935",
            "fax_number": "704-333-7238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "NEWSOME",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-375-3935",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0203Q",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4418381",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6382063",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909651",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLPATH",
            "identifier": "108363",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "295758",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Charlotte, NC
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.