Individual provider Active NPI

Doug V Reeves, O.D.

  • Optometrist
  • Rome, GA
National Provider Identifier
1821140260
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
963 Issued in GA
Practice address
1102 Martha Berry Blvd NE
Rome, GA 30165-1612
Phone
(706) 291-4642
Fax
(706) 291-9644
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 963 GA Primary

Addresses

Primary practice location

1102 Martha Berry Blvd NE
Rome, GA 30165-1612

Mailing address

1102 Martha Berry Blvd NE
Rome, GA 30165-1612
Phone (706) 291-4642

Other identifiers 1

IdentifierTypeStateIssuer
4000004386AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20111208000096 GA Practitioner - Optometry 1759556467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1981
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

109 John Maddox Dr NW
Suite 240
Rome, GA 30165-1452
Phone (706) 291-4642

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
963GAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rome Eye Care CurrentSince Oct 1, 1987 Accepting new patients

Locations

109 John Maddox Dr NW
Ste 240
Rome, GA 30165
Phone (706) 291-4642

1102 Martha Berry Blvd NE
Rome, GA 30165
Phone (706) 291-4642

10366 Commerce St
Summerville, GA 30747
Phone (706) 346-8629

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1821140260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 MARTHA BERRY BLVD NE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651612",
            "telephone_number": "706-291-4642",
            "fax_number": "706-291-9644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 MARTHA BERRY BLVD NE",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651612",
            "telephone_number": "706-291-4642",
            "fax_number": "706-291-9644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REEVES",
        "first_name": "DOUG",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4000004386A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

Verify at the official NPI Registry.