Active NPI
Picayune Eye Clinic
- Optometrist
- Picayune, MS
National Provider Identifier
1922067016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 559
- Legal business name
- PICAYUNE EYE CLINIC
- Practice address
- 908 Sixth Ave
Picayune, MS 39466-3802 - Phone
- (601) 798-4182
- Fax
- (601) 798-4770
- NPI assigned
- Mar 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lori L Blackmer, O.D.
- Title
- Owner
- Phone
- (601) 798-4182
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 559 | MS | Primary |
Addresses
Primary practice location
908 Sixth Ave
Picayune, MS 39466-3802
Mailing address
908 Sixth Ave
Picayune, MS 39466-3802
Phone (601) 798-4182
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00087010 | Medicaid | MS | |
| 263673909 | Other | MS | BLUE CROSS BLUE SHIELD |
| DA2690 | Other | MS | MEDICARE/RR GROUP |
| 0661580001 | Other | PALMETTOGBA | |
| 2230045 | Other | MS | UNITED HEALTH CARE |
| 410012249 | Other | MS | MEDICARE RAILROAD RETIREM |
| C02306 | Other | MS | MEDICARE GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930002053 | MS | DME Supplier - Physician - Optometrist | 1456470848 | Practice locations: Picayune, MS |
| O20101019000170 | MS | Part B Supplier - Clinic/Group Practice | 1456470848 |
Receives reassigned benefits from 5 practitioners Practice locations: Picayune, MS |
Laboratory certificates & supplier records
Derived by NPIMapThese 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
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Picayune Eye Clinic | Prosthetic Lenses: Conventional Eyeglasses | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Picayune Eye Clinic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Poplarville, MS
- NPI 1659546802
Locations
1249 S Main St
Ste C
Poplarville, MS 39470
Phone (601) 795-0137
1249 S Main St
Poplarville, MS 39470
Phone (601) 795-0137
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": "1142812800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1268870400000",
"number": "1922067016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908 SIXTH AVE",
"city": "PICAYUNE",
"state": "MS",
"postal_code": "394663802",
"telephone_number": "601-798-4182",
"fax_number": "601-798-4770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "908 SIXTH AVE",
"city": "PICAYUNE",
"state": "MS",
"postal_code": "394663802",
"telephone_number": "601-798-4182",
"fax_number": "601-798-4770"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PICAYUNE EYE CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-20",
"last_updated": "2010-03-18",
"status": "A",
"authorized_official_last_name": "BLACKMER",
"authorized_official_first_name": "LORI",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "601-798-4182",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "MS",
"license": "559",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00087010",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "263673909",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE/RR GROUP",
"identifier": "DA2690",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTOGBA",
"identifier": "0661580001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "2230045",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD RETIREM",
"identifier": "410012249",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "C02306",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Picayune, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; 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.