Custom Optical of Fondren LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

CUSTOM OPTICAL OF FONDREN LLC

Practice address

661 Duling Ave
Jackson, MS 39216-4008

Phone

(601) 362-6675

Fax

(601) 362-5767

NPI assigned

Mar 4, 2008

Last updated

Apr 29, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Patricia HammonsNPI 1528236973

Title

Owner/Optician

Phone

(601) 362-6675

Specialties & licenses 1

Addresses

Other names 1

• Custom Optical Of Fondren LLC Other name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

Medicare medical equipment & supply locations

Locations

Practitioners 1

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.

• Patricia Hammons

  • Optician
  • Jackson, MS
  • NPI 1528236973
  NPD Authorized official

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651190400000",
    "number": "1467622605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 DULING AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164008",
            "telephone_number": "601-362-6675",
            "fax_number": "601-362-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 DULING AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164008",
            "telephone_number": "601-362-6675",
            "fax_number": "601-362-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM OPTICAL OF FONDREN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "HAMMONS",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "OWNER/OPTICIAN",
        "authorized_official_telephone_number": "601-362-6675"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Jackson",
            "affiliation": "N",
            "endpointDescription": "customoptical@hotmail.com",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Jackson",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Customoptical@hotmail.com",
            "address_1": "661 Duling Ave",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "customoptical@hotmail.com",
            "affiliation": "N",
            "address_1": "661 Duling Ave",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Custom Optical Of Fondren LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custom Optical Of Fondren LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Custom Optical Of Fondren LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Eyewear Supplier in Jackson, MS
• Providers in Jackson, MS by specialty
• Eyewear Supplier in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; 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.