Mark Joseph Roy III, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1354-488T Issued in LA

Practice address

640 Saint Charles St
Thibodaux, LA 70301-3422

Phone

(985) 446-1717

Fax

(985) 446-9542

NPI assigned

Mar 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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

Specialty

Optometry

Education

Southern College of Optometry, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Thibodaux Vision Center Inc

  • Optometrist
  • Thibodaux, LA
  • NPI 1568634038
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1851360424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 SAINT CHARLES ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703013422",
            "telephone_number": "985-446-1717",
            "fax_number": "985-446-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 SAINT CHARLES ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703013422",
            "telephone_number": "985-446-1717",
            "fax_number": "985-446-9542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROY",
        "first_name": "MARK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1354-488T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1128015",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Michael Roundtree, DDS
• Jazsmin Roundtree
• Rouses Discount Phcy
• Amanda Rousse, LPC
• Darian Scurlock Rousse, FNP-C
• Tiffany Adams Ruester, RDN
• Tina G Rumore, LPC
• Russ Parks MD LLC
• Gianna Russell
• Thomas Wesley Ruth, PHARM D

• Optometrist in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.