Individual provider Active NPI

Mark C Ferris

  • Optometrist
  • Jasper, AL
National Provider Identifier
1922102425
Registry record updated Aug 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S-677-TA-182 Issued in AL
Practice address
309 19TH St E
Jasper, AL 35501-5413
Phone
(205) 221-2033
Fax
(205) 221-2035
NPI assigned
Sep 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X S-677-TA-182 AL Primary

Addresses

Primary practice location

309 19TH St E
Jasper, AL 35501-5413

Mailing address

309 19TH St E
Jasper, AL 35501-5413

Other identifiers 1

IdentifierTypeStateIssuer
000038536MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130717000364 AL Practitioner - Optometry 3870733710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

309 19TH St E
Jasper, AL 35501-5413

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S-677-TA-182ALMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ferris Eye Clinic Optometrist CurrentSince Jul 17, 2013 Accepting new patients

Locations

309 19th St E
Jasper, AL 35501
Phone (205) 203-8465

Organizations & group practices 1

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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186444800000",
    "number": "1922102425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 19TH ST E",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355015413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 19TH ST E",
            "city": "JASPER",
            "state": "AL",
            "postal_code": "355015413",
            "telephone_number": "205-221-2033",
            "fax_number": "205-221-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERRIS",
        "first_name": "MARK",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-677-TA-182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000038536",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, AL

Sources for this page

Verify at the official NPI Registry.