Roanoke Vision Associates

Primary specialty

OptometristTaxonomy code 152W00000X

License

8216 Issued in TX

Legal business name

ROANOKE VISION ASSOCIATES

Doing business as

Vision Source Trophy Club

Practice address

856 E Highway 114 Ste 100
Roanoke, TX 76262-6790

Phone

(682) 237-2103

NPI assigned

Aug 25, 2015

Last updated

Dec 1, 2020By 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

Kelvin Lam, ODNPI 1265871222

Title

President

Phone

(469) 464-5949

Specialties & licenses 1

Addresses

Other names 1

• Vision Source Trophy Club Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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.

• Kelvin Lam, O.D.

  • Optometrist
  • Roanoke, TX
  • NPI 1265871222
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1689041634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 TROPHY LAKE DR",
            "address_2": "STE 128",
            "city": "TROPHY CLUB",
            "state": "TX",
            "postal_code": "762625238",
            "telephone_number": "682-237-2103",
            "fax_number": "682-803-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "856 E HIGHWAY 114 STE 100",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762626790",
            "telephone_number": "682-237-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE VISION ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "KELVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-464-5949",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source Trophy Club",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vision Source Trophy Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alejandra Cristina Rivas, DDS
• RLS Supermarkets LLC (Minyard Pharmacy #49)
• Roanoke Dental Group,PC (Roanoke Dental Group and Orthodontics)
• Roanoke Family Eyecare Center, PLLC
• Roanoke Foot & Ankle Institute, PLLC
• Cheryl Ann Robinson, RD, LD
• Sara Robison, DMD
• Diana Alejandra Rojas, ELECTROLOGIST/ AEST
• Olena Romenska, M.D.
• Yu Rong

• Optometrist in Roanoke, TX
• Providers in Roanoke, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.