Active NPI
Gary Arthur Roach, O.D.
- Optometrist
- Mooresville, NC
National Provider Identifier
1922007251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 863
- Practice address
- 404 E Center Ave
Mooresville, NC 28115-2544 - Phone
- (704) 663-3924
- Fax
- (704) 663-7057
- NPI assigned
- Jul 19, 2005
- Reactivated
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 863 | NC | Primary |
Addresses
Primary practice location
404 E Center Ave
Mooresville, NC 28115-2544
Mailing address
404 E Center Ave
Mooresville, NC 28115-2544
Phone (704) 663-3924
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8909775 | Medicaid | NC | |
| 15906 | Other | NC | PARTNERS |
| 2209268 | Other | NC | UNITED HEALTHCARE |
| 09775 | Other | NC | BCBS |
| 0236390001 | Other | NC | PALMETTO DMERC |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 863 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416441600000",
"number": "1922007251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 E CENTER AVE",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281152544",
"telephone_number": "704-663-3924",
"fax_number": "704-663-7057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 E CENTER AVE",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281152544",
"telephone_number": "704-663-3924",
"fax_number": "704-663-7057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "GARY",
"middle_name": "ARTHUR",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-19",
"last_updated": "2014-11-20",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "863",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8909775",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "15906",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2209268",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "09775",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO DMERC",
"identifier": "0236390001",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mooresville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.