NPIMap

Organization Active NPI

Mobile Vision of South Carolina, LLC

  • Optometrist
  • Louisville, KY
National Provider Identifier
1659731560
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1922 Issued in SC
Legal business name
MOBILE VISION OF SOUTH CAROLINA, LLC
Practice address
12910 Shelbyville Rd
Suite 300
Louisville, KY 40243-2404
Phone
(502) 244-2441
NPI assigned
Mar 4, 2016
Last updated
Mar 4, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

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

Authorized official

Name
Delia Ritter, XX
Title
Credentialing Coordinator
Phone
(502) 244-2441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1922 SC Primary

Addresses

Primary practice location

12910 Shelbyville Rd
Suite 300
Louisville, KY 40243-2404

Mailing address

12910 Shelbyville Rd
Suite 300
Louisville, KY 40243-2404
Phone (502) 244-2441

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160420001690 SC Part B Supplier - Clinic/Group Practice 1951609155 Receives reassigned benefits from 25 practitioners
Practice locations: Sumter, SC; Summerville, SC; Piedmont, SC; Greenville, SC; Fork, SC; Georgetown, SC; Bluffton, SC; Columbia, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1659731560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12910 SHELBYVILLE RD",
            "address_2": "SUITE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432404",
            "telephone_number": "502-244-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12910 SHELBYVILLE RD",
            "address_2": "SUITE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432404",
            "telephone_number": "502-244-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE VISION OF SOUTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "RITTER",
        "authorized_official_first_name": "DELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "502-244-2441",
        "authorized_official_credential": "XX"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.