Malique Roxanne Payne, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002483 Issued in GA

Practice address

125 Pavilion Pkwy
Fayetteville, GA 30214-4098

Phone

(770) 460-7894

Fax

(770) 719-4392

NPI assigned

Sep 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Optometry

Education

State University of New York - State College Optometry, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Premier Vision Services

  • Optometrist
  • Atlanta, GA
  • NPI 1508681289
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1457546376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PAVILION PKWY",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144098",
            "telephone_number": "770-460-7894",
            "fax_number": "770-719-4392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 PAVILION PKWY",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144098",
            "telephone_number": "770-460-7894",
            "fax_number": "770-719-4392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1569 N Expressway",
            "address_purpose": "LOCATION",
            "city": "Griffin",
            "state": "GA",
            "postal_code": "302231746",
            "country_code": "US",
            "telephone_number": "770-233-6860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "MALIQUE",
        "middle_name": "ROXANNE",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-13",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "R-227-TA-984",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007182",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Paul
• Kayode Paul
• Paulk Chiropractic-Fayettevill Inc.
• Eulene Paulk, LCSW
• Stacey Nicole Paxton, LPC
• Luevonia Payton
• Pca Interventional Spine at Fayette, LLC
• Peach Fits,Inc
• Peachtree Detox LLC
• Peachtree Fayette Women'S Specialists

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.