Crater Vision Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

CRATER VISION INC

Practice address

3333 S Crater Rd Ste 2D
Petersburg, VA 23805-9276

Phone

(804) 732-3937

Fax

(807) 733-6005

NPI assigned

Nov 14, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Mark E MooreNPI 1730289935

Title

Owner

Phone

(804) 732-3937

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• crater vision center Former legal business name

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Edward Moore, O.D.

  • Optometrist
  • Petersburg, VA
  • NPI 1730289935
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499299200000",
    "number": "1497935829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 S CRATER RD STE 2D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059276",
            "telephone_number": "804-732-3937",
            "fax_number": "807-733-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 S CRATER RD STE 2D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059276",
            "telephone_number": "804-732-3937",
            "fax_number": "807-733-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRATER VISION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2017-07-06",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-732-3937",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009235221",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "080634",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "crater vision center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "crater vision center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Susan Spencer Covington, PMHNP
• Jeri Cox
• Deborah L Craft, RN
• Crater Child Development Clinic
• Crater Community Hospice Inc
• Creating Meaningful Solutions LLC
• Titoni Levon Crenshaw, QMHP, CSAC
• Crippled Children'S Hospital
• Jacqueline Croarkin
• Evelyn Crotty

• Optometrist in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2017; 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.