NPIMap

Individual provider Active NPI

Richard A Nelson, OD

  • Optometrist
  • Thomson, GA
National Provider Identifier
1912934803
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT001682 Issued in GA
Practice address
2205 Harrison Road
Wal-Mart Vision Center
Thomson, GA 30824
Phone
(706) 595-9534
Fax
(706) 595-6512
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1032 SC
Optometrist 152W00000X OPT001682 GA Primary

Addresses

Primary practice location

2205 Harrison Road
Wal-Mart Vision Center
Thomson, GA 30824

Mailing address

PO Box 5721
Attn: Administrator
Columbia, SC 29250
Phone (803) 779-2273

Other identifiers 2

IdentifierTypeStateIssuer
20047638OtherSCSELECT HEALTH OF SC
D10325MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT001682GAMDOptometrist
1032SCMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eyewear Inc Optometrist Past Accepting new patients
Folline Opticians Inc Optometrist Past Accepting new patients
Folline Opticians Inc Optometrist Past Accepting new patients
Folline Opticians Inc Optometrist Past Accepting new patients

Organizations & group practices 4

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912934803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5721",
            "address_2": "ATTN: ADMINISTRATOR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29250",
            "telephone_number": "803-779-2273",
            "fax_number": "803-799-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 HARRISON ROAD",
            "address_2": "WAL-MART VISION CENTER",
            "city": "THOMSON",
            "state": "GA",
            "postal_code": "30824",
            "telephone_number": "706-595-9534",
            "fax_number": "706-595-6512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1032",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT HEALTH OF SC",
            "identifier": "20047638",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D10325",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.