Active NPI
James T. Beverly III, OD
- Optometrist
- Macon, GA
National Provider Identifier
1376562850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1471
- Practice address
- 635 Pio Nono Ave
Macon, GA 31204 - Phone
- (478) 803-0001
- Fax
- (478) 254-4997
- NPI assigned
- Jul 18, 2006
- 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 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1471 | GA | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 1471 | GA | |
| Low Vision Rehabilitation Optometrist | 152WL0500X | 1471 | GA | |
| Pediatric Optometrist | 152WP0200X | 1471 | GA | |
| Sports Vision Optometrist | 152WS0006X | 1471 | GA | |
| Vision Therapy Optometrist | 152WV0400X | 1471 | GA | |
| Occupational Vision Optometrist | 152WX0102X | 1471 | GA |
Addresses
Primary practice location
635 Pio Nono Ave
Macon, GA 31204
Mailing address
635 Pio Nono Ave
Macon, GA 31204
Phone (478) 803-0001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000687981G | Medicaid | GA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1471 | GA | MD | Vision Therapy Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262217600000",
"number": "1376562850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 PIO NONO AVE",
"city": "MACON",
"state": "GA",
"postal_code": "31204",
"telephone_number": "478-803-0001",
"fax_number": "478-254-4997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 PIO NONO AVE",
"city": "MACON",
"state": "GA",
"postal_code": "31204",
"telephone_number": "478-803-0001",
"fax_number": "478-254-4997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVERLY",
"first_name": "JAMES",
"middle_name": "T.",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2009-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "1471",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "GA",
"license": "1471",
"primary": false
},
{
"code": "152WL0500X",
"taxonomy_group": "",
"desc": "Optometrist, Low Vision Rehabilitation",
"state": "GA",
"license": "1471",
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "GA",
"license": "1471",
"primary": false
},
{
"code": "152WS0006X",
"taxonomy_group": "",
"desc": "Optometrist, Sports Vision",
"state": "GA",
"license": "1471",
"primary": false
},
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "GA",
"license": "1471",
"primary": false
},
{
"code": "152WX0102X",
"taxonomy_group": "",
"desc": "Optometrist, Occupational Vision",
"state": "GA",
"license": "1471",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000687981G",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.