NPIMap

Organization Active NPI

Chatham Optometric OD PA

  • Optometrist
  • Chapel Hill, NC
National Provider Identifier
1386861326
Registry record updated Apr 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CHATHAM OPTOMETRIC OD PA
Practice address
11312 US Highway 15-501 North
Ste 304
Chapel Hill, NC 27517-6376
Phone
(919) 933-6767
Fax
(919) 933-6732
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2012

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

Authorized official

Name
Dr. John Bryan Marshall, O.D.
Title
President
Phone
(919) 933-6767

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X NC
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

11312 US Highway 15-501 North
Ste 304
Chapel Hill, NC 27517-6376

Mailing address

11312 US Highway 15-501 North
Ste 304
Chapel Hill, NC 27517-6376
Phone (919) 933-6767

Other identifiers 4

IdentifierTypeStateIssuer
790136LMedicaidNC
8909104MedicaidNC
4480650001OtherNCMEDICARE PTAN
152W00000XOtherNCTAXONOMY NUMBER

Other names 1

  • Carolina Vision Associates Doing business as

National Provider Directory

National Provider Directory

Locations

11312 US 15 501 N
Ste 304
Chapel Hill, NC 27517
Phone (919) 933-6767

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1386861326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11312 US HIGHWAY 15-501 NORTH",
            "address_2": "STE 304",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275176376",
            "telephone_number": "919-933-6767",
            "fax_number": "919-933-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11312 US HIGHWAY 15-501 NORTH",
            "address_2": "STE 304",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275176376",
            "telephone_number": "919-933-6767",
            "fax_number": "919-933-6732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHATHAM OPTOMETRIC OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-933-6767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790136L",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909104",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "4480650001",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY NUMBER",
            "identifier": "152W00000X",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Vision Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chapel Hill, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; 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.