Indigo Vision Center PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

1279 Issued in SC

Legal business name

INDIGO VISION CENTER PA

Practice address

302 Church St
Georgetown, SC 29440-2406

Phone

(843) 546-2244

Fax

(843) 546-2255

NPI assigned

Sep 10, 2007

Last updated

Jul 9, 2013By 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. Owen C Johnson, O.D.NPI 1346292059

Title

Owner

Phone

(843) 546-2244

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Locations

Practitioners 4

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.

• Owen Cannon Johnson, O.D.

  • Optometrist
  • Georgetown, SC
  • NPI 1346292059
  Medicare reassignment Care Compare group NPD Authorized official
• Aubrey Anna Gall, OD

  • Optometrist
  • Georgetown, SC
  • NPI 1487452462
  Medicare reassignment Care Compare group NPD
• Michelle West Nagro, OD

  • Optometrist
  • Georgetown, SC
  • NPI 1104497981
  Medicare reassignment Care Compare group NPD
• Jennifer L Johnson, PA-C

  • Medical Physician Assistant
  • Pawley's Island, SC
  • NPI 1760588388
  NPD

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1700071149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 CHURCH ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402406",
            "telephone_number": "843-546-2244",
            "fax_number": "843-546-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 CHURCH ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402406",
            "telephone_number": "843-546-2244",
            "fax_number": "843-546-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO VISION CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "OWEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-546-2244",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D12791",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00151729",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Holmes, COSMETOLOGIST
• Salem Zeglin Hough, RDN
• Kevin R Hrtyanski
• Ikechukwu Kennedy Ihewunwa, PHARMD
• In-Home Healthcare Services, Inc (Home Aide)
• Inlet Cardiopulmonary & Associates
• Island Anesthesia Services LLC
• J & C Mobile, LLC
• J&J Repair
• Curtis Jamison Jr., MD

• Optometrist in Georgetown, SC
• Providers in Georgetown, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.