NPIMap

Organization Active NPI

Academy Eye Center Optometry, PA

  • Optometrist
  • Randleman, NC
National Provider Identifier
1609909555
Registry record updated Jan 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1464 Issued in NC
Legal business name
ACADEMY EYE CENTER OPTOMETRY, PA
Practice address
209 W Naomi St
Randleman, NC 27317-1733
Phone
(336) 495-5700
Fax
(336) 495-1174
NPI assigned
Mar 13, 2007
Last updated
Jan 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2011

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

Authorized official

Name
Danford Raynor, OD
Title
President
Phone
(336) 460-0499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1464 NC Primary

Addresses

Primary practice location

209 W Naomi St
Randleman, NC 27317-1733

Mailing address

1120 Randolph St
Suite 32
Thomasville, NC 27360-5174
Phone (336) 475-0143

Other identifiers 3

IdentifierTypeStateIssuer
0853510001OtherNCCIGNA GOVERNMENT SERVIES MEDICARE PART B DME
011KTOtherNCBCBS GROUP-R
89011KPMedicaidNC

National Provider Directory

National Provider Directory

Locations

209 W Naomi St
Randleman, NC 27317
Phone (336) 495-5700

Practitioners & affiliated clinicians

Practitioners 6

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": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294358400000",
    "number": "1609909555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 RANDOLPH ST",
            "address_2": "SUITE 32",
            "city": "THOMASVILLE",
            "state": "NC",
            "postal_code": "273605174",
            "telephone_number": "336-475-0143",
            "fax_number": "336-472-6831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W NAOMI ST",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273171733",
            "telephone_number": "336-495-5700",
            "fax_number": "336-495-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMY EYE CENTER OPTOMETRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2011-01-07",
        "status": "A",
        "authorized_official_last_name": "RAYNOR",
        "authorized_official_first_name": "DANFORD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-460-0499",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GOVERNMENT SERVIES MEDICARE PART B DME",
            "identifier": "0853510001",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP-R",
            "identifier": "011KT",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011KP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Randleman, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2011; 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.