Optical Illusions, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT0001798 Issued in GA

Legal business name

OPTICAL ILLUSIONS, P.C.

Doing business as

Vision Source Family Eye Care

Practice address

90 Village at Glynn PL
Brunswick, GA 31525-1993

Phone

(912) 264-6000

Fax

(912) 264-0808

NPI assigned

Jan 9, 2007

Last updated

Jan 23, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ian Buchli, O.D.NPI 1003875386

Title

Ceo

Phone

(912) 264-6000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vision Source Family Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Optical Illusions PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Optical Illusions, PC

  dba Vision Source Partners

  • Optometrist
  • Saint Marys, GA
  • NPI 1346390895
  NPD tax ID

Locations

Practitioners 2

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.

• Ian Buchli, O.D.

  • Optometrist
  • Brunswick, GA
  • NPI 1003875386
  Medicare reassignment Authorized official
• Andrew Glen Knezich, OD

  • Optometrist
  • Brunswick, GA
  • NPI 1578546214
  NPD (past)

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1669521886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 VILLAGE AT GLYNN PL",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315251993",
            "telephone_number": "912-264-6000",
            "fax_number": "912-264-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 VILLAGE AT GLYNN PL",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315251993",
            "telephone_number": "912-264-6000",
            "fax_number": "912-264-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL ILLUSIONS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2014-01-23",
        "status": "A",
        "authorized_official_last_name": "BUCHLI",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-264-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT0001798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000954291B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Old Town Outpatient LLC
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• Michael Brandon Omar, MD/MBBS
• Oncology Medical Center PC
• Open MRI of Brunswick LLC
• Optim Orthopedics, LLC (Optim Orthopedics)
• Kristin Stenzel Orendorf, FNP-C
• Carlee Owens, LMFT
• Timothy Ryan Owens, M.D.
• James Padgett

• Optometrist in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; 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.