Jerry M Overall, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT000678 Issued in GA

Practice address

208 Smith St
Lagrange, GA 30240-2755

Phone

(706) 882-0166

Fax

(706) 883-7363

NPI assigned

Apr 27, 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 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

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.

• Rainey Professional Association

  • Optometrist
  • Lagrange, GA
  • NPI 1255399184
  Medicare reassignment NPD

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193788800000",
    "number": "1871550426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 SMITH ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402755",
            "telephone_number": "706-882-0166",
            "fax_number": "706-883-7363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 SMITH ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402755",
            "telephone_number": "706-882-0166",
            "fax_number": "706-883-7363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVERALL",
        "first_name": "JERRY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2007-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT000678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00004496A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chima Onwukeme
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• Marla Michele Osborne, BS IN SOCIAL WORK
• Brandy Nichols Owens, PA
• Samantha Lauren Owens
• Candace Anita Owensby, FNP-C
• P4 Physical Therapy Limited Partnership
• P4 Physical Therapy Limited Partnership

• Optometrist in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.