NPIMap

Organization Active NPI

Gary a. Roach, O.D., P.a.

  • Optometrist
  • Mooresville, NC
National Provider Identifier
1922015049
Registry record updated Feb 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
863 Issued in NC
Legal business name
GARY A. ROACH, O.D., P.A.
Practice address
404 E Center Ave
Mooresville, NC 28115-2544
Phone
(704) 663-3924
Fax
(704) 663-7057
NPI assigned
Aug 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2008

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

Authorized official

Name
Dr. Gary Arthur Roach, O.D.
Title
President
Phone
(704) 663-3924

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 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

IdentifierTypeStateIssuer
018TFOtherNCBCBS
DG1209OtherNCMEDICARE RAILROAD
2209268OtherNCUNITED HEALTHCARE
15906OtherNCPARTNERS MEDICARE CHOICE
5906031MedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1922015049",
    "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": {
        "organization_name": "GARY A. ROACH, O.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-663-3924",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "018TF",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DG1209",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2209268",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS MEDICARE CHOICE",
            "identifier": "15906",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906031",
            "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 Feb 14, 2008; 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.