NPIMap

Organization Active NPI

1162 Military Trail LLC

Doing business as Optometric Eyecare Center

  • Corneal and Contact Management Optometrist
  • West Palm Beach, FL
National Provider Identifier
1538417720
Registry record updated Aug 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
Legal business name
1162 MILITARY TRAIL LLC
Doing business as
Optometric Eyecare Center
Practice address
1616 S Military TRL
West Palm Beach, FL 33415-5612
Phone
(561) 968-1234
Fax
(561) 967-9178
NPI assigned
Aug 21, 2012
Last updated
Aug 21, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2012

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

Authorized official

Name
Galen Grayson, M.D.
Title
Owner/Medical Director
Phone
(704) 295-0001

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X

Addresses

Primary practice location

1616 S Military TRL
West Palm Beach, FL 33415-5612

Mailing address

8076 W Sahara Ave
Las Vegas, NV 89117-7930
Phone (877) 881-0022

Other names 1

  • Optometric Eyecare Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
1162 Military Trail LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1616 S Military Trl
West Palm Beach, FL 33415
Phone (561) 968-1234

8076 W Sahara Ave
Las Vegas, NV 89117
Phone (877) 881-0022

NPI Registry JSON

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345507200000",
    "number": "1538417720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8076 W SAHARA AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177930",
            "telephone_number": "877-881-0022",
            "fax_number": "702-543-0314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 S MILITARY TRL",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334155612",
            "telephone_number": "561-968-1234",
            "fax_number": "561-967-9178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1162 MILITARY TRAIL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-21",
        "last_updated": "2012-08-21",
        "status": "A",
        "authorized_official_last_name": "GRAYSON",
        "authorized_official_first_name": "GALEN",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "704-295-0001",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optometric Eyecare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.