NPIMap

Organization Active NPI

The Vision Clinic of Vicksburg LLC

  • Optometrist
  • Vicksburg, MS
National Provider Identifier
1871602862
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
487 Issued in MS
Legal business name
THE VISION CLINIC OF VICKSBURG LLC
Practice address
1808 Mission 66
Vicksburg, MS 39180-3710
Phone
(601) 636-6364
Fax
(601) 636-1162
NPI assigned
Aug 30, 2006
Last updated
Jul 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Dr. William Samuel Ashley, O.D.NPI 1952410011
Title
Owner/President
Phone
(601) 636-6364

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 487 MS
Optometrist 152W00000X 487 MS Primary

Addresses

Primary practice location

1808 Mission 66
Vicksburg, MS 39180-3710

Mailing address

1808 Mission 66
Vicksburg, MS 39180-3710
Phone (601) 636-6364

Other identifiers 1

IdentifierTypeStateIssuer
00087909MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930007478 MS DME Supplier - Physician - OptometristDME Supplier - Optician 9830306406 Practice locations: Vicksburg, MS
O20110113000738 MS Part B Supplier - Clinic/Group Practice 9830306406 Receives reassigned benefits from 3 practitioners
Practice locations: Vicksburg, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
The Vision Clinic1808 Mission 66, Vicksburg, MS 39180-3710(601) 636-6364 Prosthetic Lenses: Conventional Eyeglasses Accepts assignmentParticipating since Sep 1, 2010

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: lacey@thevisionclinic.eyefinity-direct.com
  • Direct secure messaging: mda4700@thevisionclinic.eyefinity-direct.com
  • Direct secure messaging: wsa538184@thevisionclinic.eyefinity-direct.com

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1871602862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803710",
            "telephone_number": "601-636-6364",
            "fax_number": "601-636-1162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803710",
            "telephone_number": "601-636-6364",
            "fax_number": "601-636-1162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VISION CLINIC OF VICKSBURG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "ASHLEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "601-636-6364",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MS",
            "license": "487",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00087909",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.