NPIMap

Organization Active NPI

Yadkin Vision Center, OD PA

  • Optometrist
  • Yadkinville, NC
National Provider Identifier
1790731305
Registry record updated Mar 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1264 Issued in NC
Legal business name
YADKIN VISION CENTER, OD PA
Practice address
902 W Main St
Yadkinville, NC 27055-7807
Phone
(336) 679-2931
Fax
(336) 677-6486
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2008

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

Authorized official

Name
Dr. Brett H. Munn, ODNPI 1336118215
Title
President
Phone
(336) 679-2931

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 1264 NC Primary

Addresses

Primary practice location

902 W Main St
Yadkinville, NC 27055-7807

Mailing address

PO Box 1757
Yadkinville, NC 27055-1757
Phone (336) 679-2931

Other identifiers 1

IdentifierTypeStateIssuer
890990AMedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1790731305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1757",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270551757",
            "telephone_number": "336-679-2931",
            "fax_number": "336-677-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 W MAIN ST",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270557807",
            "telephone_number": "336-679-2931",
            "fax_number": "336-677-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YADKIN VISION CENTER, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "MUNN",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-679-2931",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890990A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yadkinville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.