Active NPI
Michael Ryan Harris, OD
- Optometrist
- Beaufort, SC
National Provider Identifier
1992858799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 633
- Practice address
- 970 Ribaut Rd
Ste 2
Beaufort, SC 29902-5492 - Phone
- (843) 524-3770
- Fax
- (854) 524-0246
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 633 | SC | Primary |
Addresses
Primary practice location
970 Ribaut Rd
Ste 2
Beaufort, SC 29902-5492
Mailing address
970 Ribaut Rd
Ste 2
Beaufort, SC 29902-5492
Phone (843) 524-3770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 245058 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100726000298 | SC | Practitioner - Optometry | 9032241104 | Practice locations: Beaufort, SC |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 1979
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
970 Ribaut Rd
Suite 2
Beaufort, SC 29902-5492
Phone (843) 524-3770
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508889600000",
"number": "1992858799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "970 RIBAUT RD",
"address_2": "STE 2",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299025492",
"telephone_number": "843-524-3770",
"fax_number": "854-524-0246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "970 RIBAUT RD",
"address_2": "STE 2",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299025492",
"telephone_number": "843-524-3770",
"fax_number": "854-524-0246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "MICHAEL",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2017-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "SC",
"license": "633",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "245058",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaufort, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2017; 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.