Active NPI
Picayune Eye Clinic
- Optometrist
- Poplarville, MS
National Provider Identifier
1659546802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 559
- Legal business name
- PICAYUNE EYE CLINIC
- Practice address
- 1249 S Main St
Poplarville, MS 39470-3313 - Phone
- (601) 795-0137
- Fax
- (601) 798-4770
- NPI assigned
- Apr 29, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lori L Blackmer, OD
- Title
- Owner
- Phone
- (601) 798-4182
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 559 | MS | Primary |
| Optometrist | 152W00000X | 584 | MS |
Addresses
Primary practice location
1249 S Main St
Poplarville, MS 39470-3313
Mailing address
908 Sixth Ave
Picayune, MS 39466
Phone (601) 798-4182
Other identifiers 20
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09014613 | Other | MS | MS MEDICAID GROUP PROV# |
| 410000163 | Other | MS | MEDICARE |
| 410012249 | Other | MS | MEDICARE RAIL ROAD |
| 425297177 | Other | MS | BLUE CROSS BLUE SHIELD |
| 00880221 | Medicaid | MS | |
| 0661580001 | Other | MS | PALMETTO GBA DMERC |
| 263673909 | Other | MS | LORI. L BLACKMER- BLUE CROSS BLUE SHIELD |
| U92635 | Other | MS | UPIN |
| 00880022 | Medicaid | MS | |
| 1346215274 | Other | MS | MARC A. HAUTOT- NPI |
| 1750350070 | Other | MS | BETHANY HARRINGTON, O.D. NPI |
| 1760451595 | Other | MS | LORI L. BLACKMER, . O.D. NPI |
| 22-30045 | Other | MS | UNITED HEALTH CARE |
| 435044954D | Other | MS | BLUE CROSS BLUE SHIELD-DR MARC A. HAUTOT |
| MS0685 | Other | MS | EYE MED |
| P00043499 | Other | MS | MEDICARE RAILROAD RETIREMENT |
| 00087010 | Other | MS | LORI L. BLACKMER, O.D. MEDICAID |
| 410000162 | Other | MS | MEDICARE-DR MARC A. HAUTOT |
| 410000267 | Other | MS | MEDICARE |
| T95634 | Other | MS | LORI L. BLACKMER, O.D. UPIN |
Other names 1
- Poplarville Eye Clinic
National Provider Directory
National Provider Directory- Tax ID family
- Picayune Eye Clinic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Picayune, MS
- NPI 1922067016
Locations
908 Sixth Ave
Picayune, MS 39466
Phone (601) 795-0137
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Picayune, MS
- NPI 1760451595
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1216166400000",
"number": "1659546802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908 SIXTH AVE",
"city": "PICAYUNE",
"state": "MS",
"postal_code": "39466",
"telephone_number": "601-798-4182",
"fax_number": "601-798-4770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1249 S MAIN ST",
"city": "POPLARVILLE",
"state": "MS",
"postal_code": "394703313",
"telephone_number": "601-795-0137",
"fax_number": "601-798-4770"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PICAYUNE EYE CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2008-04-29",
"last_updated": "2008-07-16",
"status": "A",
"authorized_official_last_name": "BLACKMER",
"authorized_official_first_name": "LORI",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "601-798-4182",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MS",
"license": "559",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MS",
"license": "584",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MS MEDICAID GROUP PROV#",
"identifier": "09014613",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "410000163",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAIL ROAD",
"identifier": "410012249",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "425297177",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00880221",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA DMERC",
"identifier": "0661580001",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LORI. L BLACKMER- BLUE CROSS BLUE SHIELD",
"identifier": "263673909",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPIN",
"identifier": "U92635",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00880022",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MARC A. HAUTOT- NPI",
"identifier": "1346215274",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BETHANY HARRINGTON, O.D. NPI",
"identifier": "1750350070",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LORI L. BLACKMER, . O.D. NPI",
"identifier": "1760451595",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "22-30045",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD-DR MARC A. HAUTOT",
"identifier": "435044954D",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYE MED",
"identifier": "MS0685",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD RETIREMENT",
"identifier": "P00043499",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LORI L. BLACKMER, O.D. MEDICAID",
"identifier": "00087010",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE-DR MARC A. HAUTOT",
"identifier": "410000162",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "410000267",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LORI L. BLACKMER, O.D. UPIN",
"identifier": "T95634",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Poplarville Eye Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Poplarville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.