Primary Vision Care Center, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT001126 Issued in GA

Legal business name

PRIMARY VISION CARE CENTER, P.C.

Practice address

629 N Expressway
D
Griffin, GA 30223-2083

Phone

(770) 229-1517

Fax

(770) 227-3877

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Keith M Stilliond, O.D.

Title

President

Phone

(770) 229-1517

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457578353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 N EXPRESSWAY",
            "address_2": "D",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302232083",
            "telephone_number": "770-229-1517",
            "fax_number": "770-227-3877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 N EXPRESSWAY",
            "address_2": "D",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302232083",
            "telephone_number": "770-229-1517",
            "fax_number": "770-227-3877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY VISION CARE CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STILLIOND",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-229-1517",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00416182C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.