NPIMap

Organization Active NPI

Eyecarecenter OD PA

  • Optometrist
  • Laurinburg, NC
National Provider Identifier
1740727189
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYECARECENTER OD PA
Practice address
509 Lauchwood Dr
Laurinburg, NC 28352-5502
Phone
(636) 200-4393
Fax
(910) 276-9254
NPI assigned
Jan 24, 2017
Last updated
Jun 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Authorized official

Name
Kenneth Allan Gregg, OD
Title
President
Phone
(252) 451-5324

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

509 Lauchwood Dr
Laurinburg, NC 28352-5502

Mailing address

PO Box 207261
Dallas, TX 75320-7261
Phone (636) 200-4393

Other identifiers 1

IdentifierTypeStateIssuer
0222680043OtherNCSUPPLIER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318001780 NC Part B Supplier - Clinic/Group Practice 7315834462 Receives reassigned benefits from 137 practitioners
42 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 40

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 40

National Provider Directory

National Provider Directory

Locations

509 Lauchwood Dr
Laurinburg, NC 28352
Phone (910) 276-0991

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560988800000",
    "number": "1740727189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207261",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207261",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 LAUCHWOOD DR",
            "city": "LAURINBURG",
            "state": "NC",
            "postal_code": "283525502",
            "telephone_number": "636-200-4393",
            "fax_number": "910-276-9254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARECENTER OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2019-06-20",
        "status": "A",
        "authorized_official_last_name": "GREGG",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-451-5324",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPPLIER NUMBER",
            "identifier": "0222680043",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurinburg, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.