NPIMap

Organization Active NPI

Village Optical LLC

  • Optometrist
  • Johns Island, SC
National Provider Identifier
1972701803
Registry record updated Apr 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
SC1029 Issued in SC
Legal business name
VILLAGE OPTICAL LLC
Practice address
634 Freshfields Drive
Johns Island, SC 29455
Phone
(843) 768-0565
Fax
(843) 768-0566
NPI assigned
Jul 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2009

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

Authorized official

Name
Dr. James D Elliott, ODNPI 1437136975
Title
Doctor
Phone
(843) 577-2047

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X SC1029 SC Primary

Addresses

Primary practice location

634 Freshfields Drive
Johns Island, SC 29455

Mailing address

130 Gardners Cir
PMB 159
Johns Island, SC 29455-5474
Phone (843) 768-0565

Other identifiers 1

IdentifierTypeStateIssuer
DA9655MedicaidSC

Other names 1

  • EyeCare Specialties of Charleston Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240876800000",
    "number": "1972701803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 GARDNERS CIR",
            "address_2": "PMB 159",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294555474",
            "telephone_number": "843-768-0565",
            "fax_number": "843-768-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 FRESHFIELDS DRIVE",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "29455",
            "telephone_number": "843-768-0565",
            "fax_number": "843-768-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2009-04-28",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "843-577-2047",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "SC",
            "license": "SC1029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA9655",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EyeCare Specialties of Charleston",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Johns Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.