NPIMap

Organization Active NPI

Myrtle Grove Optical, LLC

  • Eyewear Supplier
  • Wilmington, NC
National Provider Identifier
1972716645
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
0735 Issued in NC
Legal business name
MYRTLE GROVE OPTICAL, LLC
Practice address
1917 Tradd CT
Wilmington, NC 28401-6638
Phone
(910) 762-2300
NPI assigned
May 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Timothy G. Kelly, M.D.NPI 1497758825
Title
Owner
Phone
(910) 762-2300

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
Eyewear Supplier 332H00000X 0735 NC Primary

Addresses

Primary practice location

1917 Tradd CT
Wilmington, NC 28401-6638

Mailing address

1917 Tradd CT
Wilmington, NC 28401-6638
Phone (910) 762-2300

National Provider Directory

National Provider Directory

Locations

1917 Tradd Ct
Wilmington, NC 28401
Phone (910) 762-2300

Practitioners & affiliated clinicians

Practitioners 1

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": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972716645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1917 TRADD CT",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016638",
            "telephone_number": "910-762-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1917 TRADD CT",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016638",
            "telephone_number": "910-762-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE GROVE OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-762-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NC",
            "license": "0735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.