Individual provider Active NPI

Trisha M Roberts, OD

  • Optometrist
  • Greer, SC
National Provider Identifier
1780731471
Registry record updated Nov 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1648 Issued in SC
Practice address
415 Brockman McClimon Rd
Greer, SC 29651-6608
Phone
(864) 989-1432
NPI assigned
Jan 4, 2007
Last updated
Nov 26, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2034 NC
Optometrist 152W00000X OEG001793 PA
Optometrist 152W00000X 1648 SC Primary

Addresses

Primary practice location

415 Brockman McClimon Rd
Greer, SC 29651-6608

Mailing address

415 Brockman McClimon Rd
Greer, SC 29651-6608
Phone (864) 989-1432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140312001770 SC Practitioner - Optometry 7719074194

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2034NCMDMarriage & Family Therapist
OEG001793PAMDOptometrist
1648SCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Premise Health of South Carolina Medical, P.C CurrentSince Dec 17, 2013 Accepting new patients
Premise Health of South Carolina Medical PC Current Accepting new patients
Premise Health of South Carolina Medical PC CurrentSince Dec 17, 2013 Accepting new patients
Kim Walters OD PA Optometrist PastSince Sep 15, 2004 Accepting new patients

Locations

10 Parkway S
Greenville, SC 29615
Phone (864) 458-6933

415 Brockman McClimon Rd
Greer, SC 29651
Phone (864) 989-1432

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416960000000",
    "number": "1780731471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 BROCKMAN MCCLIMON RD",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296516608",
            "telephone_number": "864-989-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 BROCKMAN MCCLIMON RD",
            "city": "GREER",
            "state": "SC",
            "postal_code": "296516608",
            "telephone_number": "864-989-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "TRISHA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2014-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2034",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG001793",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greer, SC

Sources for this page

Verify at the official NPI Registry.