Benjamin Carroll Poovey – Optician in Fairlawn, VA

Key facts

NPI: 1487428660
Entity type: Individual (NPI type 1)
Primary specialty: Optician 156FX1800X
License: 1101004468 (VA)
Practice address: 7373 Peppers Ferry Blvd
Fairlawn, VA 24141-8857
Phone: (540) 731-4090
Fax: (540) 731-4089
NPI assigned: Nov 8, 2023
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1101004468	VA	MD	Optician

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optician	156FX1800X	1101004468	VA	Yes

Addresses

Primary practice location

7373 Peppers Ferry Blvd
Fairlawn, VA 24141-8857

Mailing address

7373 Peppers Ferry Blvd
Fairlawn, VA 24141-8857

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 8, 2023.

{
    "created_epoch": "1699401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1487428660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7373 PEPPERS FERRY BLVD",
            "city": "FAIRLAWN",
            "state": "VA",
            "postal_code": "241418857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 PEPPERS FERRY BLVD",
            "city": "FAIRLAWN",
            "state": "VA",
            "postal_code": "241418857",
            "telephone_number": "540-731-4090",
            "fax_number": "540-731-4089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOVEY",
        "first_name": "BENJAMIN",
        "middle_name": "CARROLL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-08",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "VA",
            "license": "1101004468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, VA

All providers in Fairlawn, VA · Optician in Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.