NPIMap

Organization Active NPI

Envision Professional Group, PLLC

Doing business as Envision Eye Care

  • Clinic/Center
  • Marion, VA
National Provider Identifier
1427155472
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
0618000072 Issued in VA
Legal business name
ENVISION PROFESSIONAL GROUP, PLLC
Doing business as
Envision Eye Care
Practice address
1020 Terrace Dr
Suite 100
Marion, VA 24354
Phone
(276) 783-5157
Fax
(276) 783-5159
NPI assigned
Sep 20, 2006
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SMYTH COUNTY EYE ASSOCIATES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Tina B Blevins
Title
Administrator
Phone
(276) 783-5157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 0618000072 VA Primary

Addresses

Primary practice location

1020 Terrace Dr
Suite 100
Marion, VA 24354

Mailing address

1020 Terrace Dr
Suite 100
Marion, VA 24354-4392
Phone (276) 783-5157

Other practice location 1

699 McBroom St NW
Abingdon, VA 24210-2590
Phone (276) 628-1134

Other practice location 2

2308 Cedar Valley Dr
Cedar Bluff, VA 24609-9302
Phone (276) 964-4171

Other practice location 3

321 Midway Medical Park
Bristol, TN 37620-1651
Phone (423) 968-3141

Other identifiers 2

IdentifierTypeStateIssuer
009234080MedicaidVA
9234080MedicaidVA

Other names 2

  • Envision Eye Care Doing business as
  • Smyth County Eye Associates, INC. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, TN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040527000853 VA Part B Supplier - Clinic/Group Practice 6406837145 Receives reassigned benefits from 2 practitioners
Practice locations: Marion, VA
O20180606001633 VA Part B Supplier - Clinic/Group Practice 5799040184 Receives reassigned benefits from 12 practitioners
Practice locations: Abingdon, VA; Marion, VA; Cedar Bluff, VA
O20180905000805 TN Part B Supplier - Clinic/Group Practice 5799040184 Receives reassigned benefits from 8 practitioners
Practice locations: Bristol, TN; Gray, TN

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2148595Envision Professional Group321 Midway Medical Pike Ste 1, Bristol, TN 37620Certificate of waiverMay 14, 2028
49D2062924Envision Eye Care - Marion1020 Terrace Drive - Suite 100, Marion, VA 24354Certificate of waiverJul 23, 2027
49D2179624Envision Professional Group, PLLC699 McBroom St, Abingdon, VA 24210Certificate of waiverFeb 26, 2028

National Provider Directory

National Provider Directory
Part of
Smyth County Eye Associates

Locations

2549 W State St
Bristol, TN 37620

321 Midway Medical Park
Bristol, TN 37620
Phone 42392921110

321 Midway Medical Park
Ste 2
Bristol, TN 37620
Phone (276) 783-5157

122 Old Gray Station Rd
Johnson City, TN 37615
Phone (276) 783-5157

122 Old Gray Station Rd
Ste A
Johnson City, TN 37615

699 McBroom St NW
Abingdon, VA 24210
Phone (276) 628-1134

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1427155472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 TERRACE DR",
            "address_2": "SUITE 100",
            "city": "MARION",
            "state": "VA",
            "postal_code": "243544392",
            "telephone_number": "276-783-5157",
            "fax_number": "276-783-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 TERRACE DR",
            "address_2": "SUITE 100",
            "city": "MARION",
            "state": "VA",
            "postal_code": "24354",
            "telephone_number": "276-783-5157",
            "fax_number": "276-783-5159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "699 McBroom St NW",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242102590",
            "country_code": "US",
            "telephone_number": "276-628-1134",
            "fax_number": "276-783-5159",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2308 Cedar Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Cedar Bluff",
            "state": "VA",
            "postal_code": "246099302",
            "country_code": "US",
            "telephone_number": "276-964-4171",
            "fax_number": "276-783-5159",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "321 Midway Medical Park",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376201651",
            "country_code": "US",
            "telephone_number": "423-968-3141",
            "fax_number": "423-964-5674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ENVISION PROFESSIONAL GROUP, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMYTH COUNTY EYE ASSOCIATES, INC.",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "BLEVINS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "276-783-5157"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": "0618000072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009234080",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9234080",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smyth County Eye Associates, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Marion, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.