Individual provider Active NPI

Daniel L Jones, O.D.

  • Optometrist
  • Southern Shores, NC
National Provider Identifier
1407812530
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2156 Issued in NC
Practice address
5569 N Croatan Hwy
Southern Shores, NC 27949-3996
Phone
(252) 441-2000
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4291 OH
Optometrist 152W00000X 2156 NC Primary

Addresses

Primary practice location

5569 N Croatan Hwy
Southern Shores, NC 27949-3996

Mailing address

PO Box 207261
Dallas, TX 75320-7261
Phone (636) 200-4393

Other practice location 1

795 US Highway 64 E
Plymouth, NC 27962-9314
Phone (252) 793-2103

Other identifiers 1

IdentifierTypeStateIssuer
0866004MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100526000688 NC Practitioner - Optometry 6608842463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyecarecenter OD PAGroup PAC ID 7315834462, 71 clinicians

Practice addresses (Care Compare)

5569 N Croatan Hwy
Kitty Hawk, NC 27949-3996
Phone (252) 441-2000

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4291OHMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecarecenter, O.D., P.a. Optometrist CurrentSince Sep 9, 2022 Accepting new patients
Eyecarecenter OD PA Optometrist Current Accepting new patients
Eyecarecenter OD PA Optometrist CurrentSince Sep 9, 2022 Accepting new patients
Portage Vision Care LLC Optometrist PastSince Jan 1, 2003 Accepting new patients
Eyecarecenter OD PA Optometrist Past Accepting new patients
C.V. Sikes,Jr. & R.B. Gotschalk PTR Optometrist Past Accepting new patients
Dr. Gregory a. Marchand and Associates, Inc. Optometrist PastSince Aug 1, 1999 Accepting new patients

Locations

819 Tiffany Blvd
Rocky Mount, NC 27804
Phone (252) 972-2020

5569 N Croatan Hwy
Southrn Shore, NC 27949
Phone (252) 261-8777

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1407812530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207261",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207261",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5569 N CROATAN HWY",
            "city": "SOUTHERN SHORES",
            "state": "NC",
            "postal_code": "279493996",
            "telephone_number": "252-441-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "795 US Highway 64 E",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "NC",
            "postal_code": "279629314",
            "country_code": "US",
            "telephone_number": "252-793-2103",
            "fax_number": "252-793-5154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JONES",
        "first_name": "DANIEL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "4291",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0866004",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southern Shores, NC

Sources for this page

Verify at the official NPI Registry.