NPIMap

Organization Active NPI

Five Forks Vision, LLC

  • Optometrist
  • Simpsonville, SC
National Provider Identifier
1609343227
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FIVE FORKS VISION, LLC
Practice address
2827 Woodruff Rd
Simpsonville, SC 29681-4807
Phone
(864) 520-2480
NPI assigned
Nov 1, 2018
Last updated
Aug 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Authorized official

Name
Gordon Stanley Johnson, ODNPI 1295841369
Title
Optometrist / Owner
Phone
(864) 520-2480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

2827 Woodruff Rd
Simpsonville, SC 29681-4807

Mailing address

2827 Woodruff Rd
Simpsonville, SC 29681-4807
Phone (864) 520-2480

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1609343227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2827 WOODRUFF RD",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296814807",
            "telephone_number": "864-520-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2827 WOODRUFF RD",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296814807",
            "telephone_number": "864-520-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE FORKS VISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-01",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "OPTOMETRIST  / OWNER",
        "authorized_official_telephone_number": "864-520-2480",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simpsonville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.