Atlas PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

ATLAS PLLC

Doing business as

Atlas PLLC

Practice address

409 Kansas City St
Rapid City, SD 57701-3636

Phone

(605) 348-2323

Fax

(605) 348-6694

NPI assigned

Nov 14, 2018

Last updated

Mar 16, 2022By 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

Antwan Percy Randolph, ODNPI 1568798841

Title

Owner

Phone

(605) 642-2533

Specialties & licenses 2

Addresses

Other names 1

• Atlas PLLC Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Atlas LLC

  dba Atlas PLLC

  • Optometrist
  • Spearfish, SD
  • NPI 1821769027

  O20211022001764

  Same enrollment

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.

• Antwan Percy Randolph, O.D.

  • Optometrist
  • Spearfish, SD
  • NPI 1568798841
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1760951107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 KANSAS CITY ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577013636",
            "telephone_number": "605-348-2323",
            "fax_number": "605-348-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 KANSAS CITY ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577013636",
            "telephone_number": "605-348-2323",
            "fax_number": "605-348-6694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2549 Yukon Pl",
            "address_purpose": "LOCATION",
            "city": "Spearfish",
            "state": "SD",
            "postal_code": "577838531",
            "country_code": "US",
            "telephone_number": "605-549-1212",
            "fax_number": "605-549-1313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATLAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-14",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "ANTWAN",
        "authorized_official_middle_name": "PERCY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-642-2533",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlas PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.