Individual provider Active NPI

David G Corcoran, O.D.

  • Optometrist
  • Greenville, SC
National Provider Identifier
1649259805
Registry record updated Nov 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
948 Issued in SC
Practice address
210 Mills Ave
Greenville, SC 29605-4020
Phone
(864) 232-2779
NPI assigned
Jan 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 948 SC
Optometrist 152W00000X 948 SC Primary

Addresses

Primary practice location

210 Mills Ave
Greenville, SC 29605-4020

Mailing address

1950 Old Gallows Rd
Suite 520
Vienna, VA 22182-3990
Phone (703) 847-8899

Other identifiers 2

IdentifierTypeStateIssuer
51-0604811OtherSCTAX ID NO.
DO9480MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20070202000338 SC Practitioner - Optometry 1052313103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

210 Mills Ave
Greenville, SC 29605-4020
Phone (864) 232-2779

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
948SCMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of South Carolina, LLC Optometrist CurrentSince May 4, 2015 Accepting new patients
Myeyedr Optometry of South Carolina, LLC Optometrist CurrentSince May 4, 2015 Accepting new patients
Myeyedr Optometry of South Carolina, LLC Optometrist Current Accepting new patients

Locations

1617 Wade Hampton Blvd
Greenville, SC 29609
Phone (864) 322-9050

210 Mills Ave
Greenville, SC 29605
Phone (803) 232-2779

812 W Wade Hampton Blvd
Greer, SC 29650
Phone (864) 877-1825

1268 Ebenezer Rd
Rock Hill, SC 29732
Phone (803) 327-2001

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1137283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511308800000",
    "number": "1649259805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD",
            "address_2": "SUITE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823990",
            "telephone_number": "703-847-8899",
            "fax_number": "703-991-0514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 MILLS AVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054020",
            "telephone_number": "864-232-2779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORCORAN",
        "first_name": "DAVID",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-15",
        "last_updated": "2017-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "SC",
            "license": "948",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID NO.",
            "identifier": "51-0604811",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DO9480",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.