Vision Source of Brunswick, OD, PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

VISION SOURCE OF BRUNSWICK, OD, PA

Practice address

4633 Long Beach Rd SE
Southport, NC 28461-8798

Phone

(910) 457-6667

Fax

(910) 457-9530

NPI assigned

Jan 14, 2019

Organization subpart

No

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

Authorized official

Name

Dr. John Michael Howard, ODNPI 1346289014

Title

President

Phone

(910) 457-6667

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 3

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

• John Michael Howard, OD

  • Optometrist
  • Southport, NC
  • NPI 1346289014
  Medicare reassignment Care Compare group NPD Authorized official
• Matthew Benko, OD

  • Optometrist
  • Southport, NC
  • NPI 1679307714
  Medicare reassignment Care Compare group NPD
• James Louis Fanelli, OPTOMETRIST

  • Optometrist
  • Wilmington, NC
  • NPI 1023144383
  NPD (past)

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

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1922572999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4633 LONG BEACH RD SE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284618798",
            "telephone_number": "910-457-6667",
            "fax_number": "910-457-9530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4633 LONG BEACH RD SE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284618798",
            "telephone_number": "910-457-6667",
            "fax_number": "910-457-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION SOURCE OF BRUNSWICK, OD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-14",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-457-6667",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Vanslyke, M.S OTR/L
• Kristos Nektarios Vaughan, D.O.
• Leigh Margaret Vaughan, D.O.
• Samantha Vaughan
• Robin Vieira, RDN
• Kalen Victoria Vogler
• Wal-Mart Stores East LP
• Wal-Mart Stores, Inc.
• Walgreen Co
• Walgreen Co

• Optometrist in Southport, NC
• Providers in Southport, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; 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.