NPIMap

Organization Active NPI

Piedmont Vision Care PLLC

  • Optometrist
  • Manassas, VA
National Provider Identifier
1649469115
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618000305 Issued in VA
Legal business name
PIEDMONT VISION CARE PLLC
Practice address
10660 Crestwood Dr
Manassas, VA 20109-3432
Phone
(703) 369-3937
Fax
(703) 369-7147
NPI assigned
Oct 19, 2007
Last updated
May 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

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

Authorized official

Name
Mary Mantini, OD
Title
Authorized Official
Phone
(309) 222-8275

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 0618000305 VA Primary

Addresses

Primary practice location

10660 Crestwood Dr
Manassas, VA 20109-3432

Mailing address

10660 Crestwood Dr
Manassas, VA 20109-3432
Phone (703) 369-3937

Other names 1

  • Thomas B Wood OD, PLLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040130000126 VA Part B Supplier - Clinic/Group Practice 8628971264 Receives reassigned benefits from 3 practitioners
Practice locations: Manassas, VA
O20200124002592 VA Part B Supplier - Clinic/Group Practice 6709211501 Receives reassigned benefits from 6 practitioners
Practice locations: Manassas, VA

National Provider Directory

National Provider Directory

Locations

10660 Crestwood Dr
Manassas, VA 20109
Phone (703) 369-3937

Practitioners & affiliated clinicians

Practitioners 10

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": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1649469115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10660 CRESTWOOD DR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201093432",
            "telephone_number": "703-369-3937",
            "fax_number": "703-369-7147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10660 CRESTWOOD DR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201093432",
            "telephone_number": "703-369-3937",
            "fax_number": "703-369-7147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT VISION CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "MANTINI",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "309-222-8275",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thomas B Wood OD, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; 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.