Fairmont Eye Clinic OD PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

FAIRMONT EYE CLINIC OD PLLC

Practice address

204 Iona St
Fairmont, NC 28340-1616

Phone

(910) 628-8316

Fax

(910) 628-5642

NPI assigned

Oct 6, 2025

Last updated

Oct 6, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samuel David Johnson, ODNPI 1962838565

Title

Owner/ Optometrist

Phone

(910) 628-8316

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel David Johnson, O.D.

  • Optometrist
  • Fairmont, NC
  • NPI 1962838565
  Medicare reassignment NPD Authorized official
• Lionel Nelson Chamberlain, OD

  • Optometrist
  • Fairmont, NC
  • NPI 1225039340
  Medicare reassignment
• Hal C Herring Jr., OD, PA

  • Optometrist
  • Fairmont, NC
  • NPI 1053312181
  Medicare reassignment

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

{
    "created_epoch": "1759708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759708800000",
    "number": "1871468413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 648",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "283400648",
            "telephone_number": "910-628-8316",
            "fax_number": "910-628-5642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 IONA ST",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "283401616",
            "telephone_number": "910-628-8316",
            "fax_number": "910-628-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRMONT EYE CLINIC OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-06",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/ OPTOMETRIST",
        "authorized_official_telephone_number": "910-628-8316",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kasey Oxendine Epps, DMD
• Samuel Gene Evans Jr., DDS
• Fairmont Area EMS & Rescue
• Fairmont Dental Inc
• Fairmont Drug Company LLC (Fairmont Drug Company)
• Fairmont Opco, LLC (Greenbrier of Fairmont)
• Family Alternatives, Inc. (Family Alternatives, Inc. Group Home # 2)
• Amanda Gem Floyd
• Latricia Lynn Freeman, LCSW
• Greenbrier LTC Inc

• Optometrist in Fairmont, NC
• Providers in Fairmont, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.