NPIMap

Organization Active NPI

C & S Optometric Services PLLC

  • Optometrist
  • New Bern, NC
National Provider Identifier
1619661600
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
C & S OPTOMETRIC SERVICES PLLC
Practice address
2038 Waterscape Way
New Bern, NC 28562
Phone
(252) 633-0016
NPI assigned
Jun 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Authorized official

Name
Shannon Kleinwolterink
Title
Practice Administrator
Phone
(252) 633-0016

Specialties & licenses 1

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

Addresses

Primary practice location

2038 Waterscape Way
New Bern, NC 28562

Mailing address

2805 Village Way
Trent Woods, NC 28562-7351
Phone (252) 633-0016

Other names 1

  • Creekside Family Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100416000165 NC Part B Supplier - Clinic/Group Practice 1153363254 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Bern, NC; Trent Woods, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
C S Optometric Services PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

2038 Waterscape Way
New Bern, NC 28562
Phone (252) 633-0016

2805 Village Way
Trent Woods, NC 28562
Phone (252) 633-0016

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1619661600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 VILLAGE WAY",
            "city": "TRENT WOODS",
            "state": "NC",
            "postal_code": "285627351",
            "telephone_number": "252-633-0016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2038 WATERSCAPE WAY",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "28562",
            "telephone_number": "252-633-0016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C & S OPTOMETRIC SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-05-17",
        "status": "A",
        "authorized_official_last_name": "KLEINWOLTERINK",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "252-633-0016"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creekside Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Bern, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; 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.