Active NPI
George W. Pegram III
- Optometrist
- Chesapeake, VA
National Provider Identifier
1720154057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0618000331
- Legal business name
- GEORGE W. PEGRAM III
- Practice address
- 1109 Poindexter St
Chesapeake, VA 23324-2424 - Phone
- (757) 545-3930
- Fax
- (757) 545-0193
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. George Worthy Pegram III, O.D.
- Title
- Owner
- Phone
- (757) 545-3930
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618000331 | VA | Primary |
Addresses
Primary practice location
1109 Poindexter St
Chesapeake, VA 23324-2424
Mailing address
1109 Poindexter St
Chesapeake, VA 23324-2424
Phone (757) 545-3930
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227443 | Other | VA | MDIPA |
| 181445 | Other | VA | ANTHEM BCBS |
National Provider Directory
National Provider Directory- Tax ID family
- George W Pegram III
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Chesapeake, VA
- NPI 1083009039
Locations
1109 Poindexter St
Chesapeake, VA 23324
Phone (757) 545-3930
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Chesapeake, VA
- NPI 1740264662
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1720154057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1109 POINDEXTER ST",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233242424",
"telephone_number": "757-545-3930",
"fax_number": "757-545-0193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1109 POINDEXTER ST",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233242424",
"telephone_number": "757-545-3930",
"fax_number": "757-545-0193"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEORGE W. PEGRAM III",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-28",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "PEGRAM",
"authorized_official_first_name": "GEORGE",
"authorized_official_middle_name": "WORTHY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "757-545-3930",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "III",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "VA",
"license": "0618000331",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MDIPA",
"identifier": "227443",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "181445",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.