Sistar Eyecare Associates

Primary specialty

OptometristTaxonomy code 152W00000X

License

919T Issued in GA

Legal business name

SISTAR EYECARE ASSOCIATES

Practice address

545 Knight Ave
Waycross, GA 31501-3354

Phone

(912) 285-0020

Fax

(912) 285-8222

NPI assigned

Mar 10, 2006

Last updated

Feb 14, 2008By 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. James Leon Sister Jr., OD

Title

Optometrist Ceo

Phone

(912) 285-0020

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1386612703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1465",
            "address_2": "545 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315021465",
            "telephone_number": "912-285-0020",
            "fax_number": "912-285-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013354",
            "telephone_number": "912-285-0020",
            "fax_number": "912-285-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISTAR EYECARE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "SISTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "OPTOMETRIST CEO",
        "authorized_official_telephone_number": "912-285-0020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "919T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00204663D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52194992",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Waycross, GA
• Providers in Waycross, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; 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.