Doctors Vision Center OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DOCTORS VISION CENTER OD PA

Practice address

335 N Main St
Walnut Cove, NC 27052-9200

Phone

(336) 591-7428

Fax

(336) 591-5136

NPI assigned

May 4, 2006

Organization subpart

No

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

Authorized official

Name

Tina M Burgess

Title

Credentialing Specialist

Phone

(252) 442-0802

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1801844840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 N MAIN ST",
            "city": "WALNUT COVE",
            "state": "NC",
            "postal_code": "270529200",
            "telephone_number": "336-591-7428",
            "fax_number": "336-591-5136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 N MAIN ST",
            "city": "WALNUT COVE",
            "state": "NC",
            "postal_code": "270529200",
            "telephone_number": "336-591-7428",
            "fax_number": "336-591-5136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS VISION CENTER OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "252-442-0802"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GRP #",
            "identifier": "017J2",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900612",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carenet Inc
• Haley Leigh-Ann Chaney, LCSWA
• Harry Mario Coletta II, MD
• Walter Crowley
• CVS
• DRS Mabe & Mabe PA
• Faith First Christian Counseling
• Faithful Living Foundation
• Foothills Eye Care, O.D., P.a.
• Heather Cashion Frazier, LCMHC; LCASA

• Optometrist in Walnut Cove, NC
• Providers in Walnut Cove, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; 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.