NPIMap

Organization Active NPI

Medical Eye Associates PA

  • Ophthalmology Physician
  • Wilson, NC
National Provider Identifier
1922094895
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MEDICAL EYE ASSOCIATES PA
Practice address
1707 Medical Park Dr W
Ste1
Wilson, NC 27893-2768
Phone
(252) 291-7008
Fax
(252) 291-1281
NPI assigned
Sep 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Authorized official

Name
Shawn C Putnam, MD
Title
Partner/President
Phone
(252) 443-6129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1707 Medical Park Dr W
Ste1
Wilson, NC 27893-2768

Mailing address

1707 Medical Park Dr W
Ste1
Wilson, NC 27893-2768
Phone (252) 291-7008

Other identifiers 12

IdentifierTypeStateIssuer
180044388OtherRR MEDICARE
180641778OtherRR MEDICARE
180041942OtherRR MEDICARE
1180LOtherBC
180041781OtherRR MEDICARE
1073659769OtherNCNPI JOHN E THORDSEN
22680OtherBC
190041779OtherRR MEDICARE
P00720248OtherRAILROAD MCEDICARE
37986OtherBC
1093VOtherBC
12630OtherBC

Other names 1

  • Wilson Optical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050809001098 NC Part B Supplier - Clinic/Group Practice 4981633914 Receives reassigned benefits from 10 practitioners
Practice locations: Rocky Mount, NC; Wilson, NC
O20100930041379 NC DME Supplier - Physician - Ophthalmology 4981633914 Practice locations: Wilson, NC

National Provider Directory

National Provider Directory

Locations

1707 Medical Park Dr W
Wilson, NC 27893
Phone (252) 243-3559

1707 Medical Park Dr W
Ste 1
Wilson, NC 27893
Phone (252) 291-7008

Practitioners & affiliated clinicians

Practitioners 10

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": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1922094895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 MEDICAL PARK DR W",
            "address_2": "STE1",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278932768",
            "telephone_number": "252-291-7008",
            "fax_number": "252-291-1281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 MEDICAL PARK DR W",
            "address_2": "STE1",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278932768",
            "telephone_number": "252-291-7008",
            "fax_number": "252-291-1281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL EYE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "PUTNAM",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER/PRESIDENT",
        "authorized_official_telephone_number": "252-443-6129",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "180044388",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "180641778",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "180041942",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "1180L",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "180041781",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI JOHN E THORDSEN",
            "identifier": "1073659769",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "22680",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "190041779",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCEDICARE",
            "identifier": "P00720248",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "37986",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "1093V",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "12630",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilson Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.