NPIMap

Organization Active NPI

Patty Vision Center OD PA

  • Optometrist
  • Yanceyville, NC
National Provider Identifier
1497798177
Registry record updated Nov 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1088 Issued in CA
Legal business name
PATTY VISION CENTER OD PA
Practice address
495 Hwy 158 West
Yanceyville, NC 27379
Phone
(336) 694-9632
Fax
(336) 694-1207
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2010

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

Authorized official

Name
Dr. Augusta Reid Patty Jr., O.D.NPI 1578516944
Title
Owner
Phone
(336) 694-9632

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1088 CA Primary

Addresses

Primary practice location

495 Hwy 158 West
Yanceyville, NC 27379

Mailing address

495 Hwy 158 West
Yanceyville, NC 27379
Phone (336) 694-9632

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040724000414 NC Part B Supplier - Clinic/Group Practice 0143200584 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
Practice locations: Mebane, NC; Roxboro, NC; Yanceyville, NC; Burlington, NC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2326 S Church St
Ste A
Burlington, NC 27215
Phone (336) 513-0073

2326 S Church St
Burlington, NC 27215
Phone (336) 513-0073

1107 S Fifth St
Ste 300
Mebane, NC 27302
Phone (919) 241-8554

2858 Durham Rd
Roxboro, NC 27573

495 US Highway 158 W
Yanceyville, NC 27379
Phone (336) 694-9632

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1497798177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 HWY 158 WEST",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "27379",
            "telephone_number": "336-694-9632",
            "fax_number": "336-694-1207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 HWY 158 WEST",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "27379",
            "telephone_number": "336-694-9632",
            "fax_number": "336-694-1207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATTY VISION CENTER OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "PATTY",
        "authorized_official_first_name": "AUGUSTA",
        "authorized_official_middle_name": "REID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-694-9632",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "1088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yanceyville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.