Individual provider Active NPI

Robert Brian Pate, O.D.

  • Optometrist
  • South Charleston, WV
National Provider Identifier
1508941675
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
899-D Issued in WV
Practice address
2700 Mountaineer Blvd
South Charleston, WV 25309-9442
Phone
(304) 744-2713
Fax
(304) 744-0704
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 899-D WV Primary

Addresses

Primary practice location

2700 Mountaineer Blvd
South Charleston, WV 25309-9442

Mailing address

2700 Mountaineer Blvd
South Charleston, WV 25309-9442
Phone (304) 744-2713

Other identifiers 1

IdentifierTypeStateIssuer
0149617000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121009000776 WV Practitioner - Optometry 9830348713 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508941675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 MOUNTAINEER BLVD",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253099442",
            "telephone_number": "304-744-2713",
            "fax_number": "304-744-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 MOUNTAINEER BLVD",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253099442",
            "telephone_number": "304-744-2713",
            "fax_number": "304-744-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATE",
        "first_name": "ROBERT",
        "middle_name": "BRIAN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "899-D",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0149617000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.