Individual provider Active NPI

William C Elmore, OD

  • Optometrist
  • Fayetteville, NC
National Provider Identifier
1669466744
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1082 Issued in NC
Practice address
1657 Owen Dr
Fayetteville, NC 28304-3425
Phone
(910) 323-2100
Fax
(910) 323-2165
NPI assigned
Sep 6, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1082 NC Primary

Addresses

Primary practice location

1657 Owen Dr
Fayetteville, NC 28304-3425

Mailing address

1657 Owen Dr
Fayetteville, NC 28304-3425
Phone (910) 323-2100

Other identifiers 2

IdentifierTypeStateIssuer
09089OtherBLUE CROSS
8909089MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20101117000907 NC Practitioner - Optometry 7618162579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Eye Care Optometric Centers PAGroup PAC ID 6800081761, 2 clinicians

Practice addresses (Care Compare)

1657 Owen Dr
Fayetteville, NC 28304-3425
Phone (910) 323-2100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1082NCMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
American Eye Care Optometric Centers PA Optometrist CurrentSince Jun 1, 2001 Accepting new patients

Locations

1657 Owen Dr
Fayetteville, NC 28304
Phone (910) 323-2100

Organizations & group practices 1

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": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263254400000",
    "number": "1669466744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1657 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043425",
            "telephone_number": "910-323-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1657 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043425",
            "telephone_number": "910-323-2100",
            "fax_number": "910-323-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMORE",
        "first_name": "WILLIAM",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2010-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "09089",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909089",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.