Jacksonville Vision Center, O.D.,PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1970 Issued in NC

Legal business name

JACKSONVILLE VISION CENTER, O.D.,PLLC

Practice address

409 Western Blvd
Suite 700
Jacksonville, NC 28546-6528

Phone

(910) 219-3937

NPI assigned

Dec 27, 2010

Reactivated

Feb 2, 2011

Last updated

Feb 2, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy A Taylor

Title

Insurance Specialist

Phone

(910) 326-0113

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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, and the practitioner matching its NPPES authorized official.

• Jared A Taylor, OD

  • Optometrist
  • Jacksonville, NC
  • NPI 1265490619
  Medicare reassignment NPD

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

{
    "created_epoch": "1293408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296604800000",
    "number": "1578867057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 WESTERN BLVD",
            "address_2": "SUITE 700",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466528",
            "telephone_number": "910-219-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 WESTERN BLVD",
            "address_2": "SUITE 700",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466528",
            "telephone_number": "910-219-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE VISION CENTER, O.D.,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-27",
        "last_updated": "2011-02-02",
        "deactivation_date": "2011-01-20",
        "reactivation_date": "2011-02-02",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "INSURANCE SPECIALIST",
        "authorized_official_telephone_number": "910-326-0113"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89093R2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Oriental Medicine Center
• Jacksonville Orthopedic Clinic, P.a.
• Jacksonville Peak Performance Sports & Physical Therapy, L.L.C.
• Jacksonville Physical Therapy Center, Inc. (Jacksonville Physical Therapy)
• Jacksonville Treatment Center
• Catherine Veronica Jacobs
• Heather Nicole Jacoby
• Paul Jacome Sanchez
• Jacob Henry Jaffe, DPT
• Melvin Wade James II, APRN

• Optometrist in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; 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.