NPIMap

Organization Active NPI

Spartanburg Vision LLC

  • Optometrist
  • Spartanburg, SC
National Provider Identifier
1760714794
Registry record updated Feb 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1321 Issued in SC
Legal business name
SPARTANBURG VISION LLC
Practice address
1200 E Main St
Suite 2
Spartanburg, SC 29307-1711
Phone
(864) 585-7807
NPI assigned
Feb 1, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2010

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

Authorized official

Name
Dr. Jeremy Anderson, O.D.NPI 1942262621
Title
Optometrist
Phone
(864) 585-7807

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)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1321 SC Primary

Addresses

Primary practice location

1200 E Main St
Suite 2
Spartanburg, SC 29307-1711

Mailing address

1200 E Main St
Suite 2
Spartanburg, SC 29307-1711
Phone (864) 585-7807

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111111000547 SC Part B Supplier - Clinic/Group Practice 3678747458 Receives reassigned benefits from 7 practitioners
Practice locations: Spartanburg, SC

National Provider Directory

National Provider Directory

Locations

1200 E Main St
Ste 2
Spartanburg, SC 29307
Phone (864) 585-7807

Practitioners & affiliated clinicians

Practitioners 7

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": "1264982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264982400000",
    "number": "1760714794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E MAIN ST",
            "address_2": "SUITE 2",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071711",
            "telephone_number": "864-585-7807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E MAIN ST",
            "address_2": "SUITE 2",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071711",
            "telephone_number": "864-585-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-01",
        "last_updated": "2010-02-01",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "864-585-7807",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; 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.