Jediah William Harrison, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618002783 Issued in VA

Practice address

843 W Stuart Dr Ste 7
Hillsville, VA 24343-1555

Phone

(276) 728-9323

NPI assigned

May 13, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WA

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

Southern College of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Family Eye Care of Duvall 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Advanced Family Eye Care of Duvall

  • Optometrist
  • Duvall, WA
  • NPI 1306229760
  Medicare reassignment Care Compare group NPD
• Duvall Advanced Family Eyecare, PS

  • Optometrist
  • Duvall, WA
  • NPI 1467582551
  NPD

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563926400000",
    "number": "1962068379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "843 W STUART DR STE 7",
            "city": "HILLSVILLE",
            "state": "VA",
            "postal_code": "243431555",
            "telephone_number": "276-728-9323",
            "fax_number": "276-728-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 W STUART DR STE 7",
            "city": "HILLSVILLE",
            "state": "VA",
            "postal_code": "243431555",
            "telephone_number": "276-728-9323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5826 Ruebush Rd",
            "address_purpose": "LOCATION",
            "city": "Dublin",
            "state": "VA",
            "postal_code": "240842252",
            "country_code": "US",
            "telephone_number": "540-674-6824",
            "fax_number": "540-674-8916",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "275 W Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Wytheville",
            "state": "VA",
            "postal_code": "243821155",
            "country_code": "US",
            "telephone_number": "276-223-0242",
            "fax_number": "276-223-0262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "JEDIAH",
        "middle_name": "WILLIAM",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1063704435",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "0618002783",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER NUMBER",
            "identifier": "1962068379",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Green Hill Home for Adults Inc.
• Thomas Nielsen Gwynn, HIS
• Warren Gwynn, O.D, M.S.
• H2 Rehabilitation Services of Virginia, LLC
• Cathy Sue Harman, LPTA
• Joshua Michael Harrod, LPC
• David M. Harvey, D.D.S
• Hashtag Home Health, LLC
• Carley Hedge
• Brooke Lauren Hill, OTR/L

• All providers in Hillsville, VA
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; 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.