Kimberly Mark Douglas, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2257 Issued in NC

Practice address

3150 Rogers Rd Ste 110
Wake Forest, NC 27587-4196

Phone

(919) 263-9163

Fax

(919) 263-9408

NPI assigned

Sep 8, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McPherson Family Eye Care OD PAGroup PAC ID 1355590969, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: direct@mcphersonfamilyeyecarewakeforestnc.compulinkdirect.com

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.

• McPherson Family Eye Care OD, PA

  • Optometrist
  • Wake Forest, NC
  • NPI 1265703607
  Medicare reassignment Care Compare group NPD
• Ballston Optometry, LLC

  • Optometrist
  • Arlington, VA
  • NPI 1083779094
  NPD (past)
• Poarch Band of Creek Indians Dba Premier Family Eye Care

  • Optometrist
  • Atmore, AL
  • NPI 1336257575
  NPD (past)

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1942533153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 KENNISON CT",
            "city": "ROLESVILLE",
            "state": "NC",
            "postal_code": "275719009",
            "telephone_number": "919-368-4668",
            "fax_number": "919-263-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 ROGERS RD STE 110",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874196",
            "telephone_number": "919-263-9163",
            "fax_number": "919-263-9408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15640 Don Lochman Ln Ste C",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282774442",
            "country_code": "US",
            "telephone_number": "704-943-5110",
            "fax_number": "704-943-4449",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11030 Golf Links Dr Ste 204",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282778047",
            "country_code": "US",
            "telephone_number": "704-943-5110",
            "fax_number": "704-943-4449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "KIMBERLY",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-08",
        "last_updated": "2024-10-03",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@McPhersonFamilyEyeCareWakeForestNC.CompulinkDirect.com",
            "affiliation": "Y",
            "affiliationName": "McPherson Family Eye Care OD, PA",
            "address_1": "3150 Rogers Rd",
            "address_2": "Suite 110",
            "city": "Wake Forest",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275874195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Optometrist in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.