Kathleen A. Clary, OD

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

0618000373 Issued in VA

Practice address

200 Mosaic Cir
Pooler, GA 31322-5025

Phone

(912) 348-4584

NPI assigned

Feb 11, 2006

Last updated

Nov 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC, GA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Comprehensive Eyecare LLC

  dba Comprehensive Eye

  • Optometrist
  • Pooler, GA
  • NPI 1932778206
  Medicare reassignment NPD
• 360Care LLC

  • Dentist
  • Louisville, KY
  • NPI 1417592536

  SC

  Medicare reassignment NPD
• Mobile Vision of South Carolina, LLC

  • Optometrist
  • Louisville, KY
  • NPI 1659731560

  SC

  Medicare reassignment NPD
• 360Care LLC

  • Audiologist
  • Columbia, SC
  • NPI 1619598281
  NPD
• Carolina Eyecare Physicians LLC

  • Ophthalmology Physician
  • N Charleston, SC
  • NPI 1659421238
  NPD
• Doran Optometry, PLLC

  • Optometrist
  • Ashburn, VA
  • NPI 1083151278
  NPD (past)

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

{
    "created_epoch": "1139616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1609849389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MOSAIC CIR",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313225025",
            "telephone_number": "912-348-4584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MOSAIC CIR",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313225025",
            "telephone_number": "912-348-4584"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 William Pope Dr Ste 6",
            "address_purpose": "LOCATION",
            "city": "Bluffton",
            "state": "SC",
            "postal_code": "299097550",
            "country_code": "US",
            "telephone_number": "843-842-2020",
            "fax_number": "843-705-1512",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "232 Nickle Plate Rd",
            "address_purpose": "LOCATION",
            "city": "Hardeeville",
            "state": "SC",
            "postal_code": "299274416",
            "country_code": "US",
            "telephone_number": "571-436-0338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARY",
        "first_name": "KATHLEEN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-11",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "VA",
            "license": "0618000373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D19772",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC MEDICARE",
            "identifier": "SCB632E499",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.revolutionehr.com",
            "affiliation": "N",
            "address_1": "200 Mosaic Cir",
            "city": "Pooler",
            "state": "GA",
            "country_code": "US",
            "postal_code": "313225025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Candace Graves Christianson, CCC-SLP
• Amber Clark
• Dyneesha-Marie Clark
• Heather Clark
• Mattea Nicole Clarke, MPH, IBCLC
• Coastal Audiology Inc. (Coastal Audiology)
• Coastal Autism Therapy Center, Inc.
• Coastal Community Health Services, Inc. (Coastal Community Pharmacy #102)
• Coastal Community Health Services, Inc. (Coastal Community Health - Pooler)
• Coastal Ear, Nose & Throat

• Corneal and Contact Management Optometrist in Pooler, GA
• Providers in Pooler, GA by specialty
• Corneal and Contact Management Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.