FAYETTE MEDICAL CLINIC OPTICAL SHOP (NPI# 1891910618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891910618 |
| Entity Type | Organization |
| Organization Name | FAYETTE MEDICAL CLINIC OPTICAL SHOP |
| Practice Address |
101 Yorktown Dr Ste 225 Fayetteville GA 30214-1568 |
| Practice Telephone | 7704602331 |
| Practice Fax Number | 7704604016 |
| Mailing Telephone | 7704602331 |
| Mailing Fax Number | 7704604016 |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. RICK RODECKER (ADMINISTRATOR) |
| Authorized Official Telephone | 4043512220 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 20001558 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
101 YORKTOWN DR STE 225 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1568 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417394404 | Hans Barron Heymann | Ophthalmology | 613 N Willow Ave, Fayetteville, AR 72701-3550 | 2013-05-30 |
| 1770821324 | Ernest Mitchell Singleton | Ophthalmology | 1793 E Manchester Dr, Fayetteville, AR 72703-6224 | 2013-01-16 |
| 1598878571 | Shelby Stephenson | Ophthalmology | 414 Owen Dr, Fayetteville, NC 28304-3416 | 2006-08-16 |
| 1871521625 | Michael George Woodcock | Ophthalmology | 2047 Valleygate Dr, Fayetteville, NC 28304-3688 | 2006-06-29 |
| 1285686865 | Jimmie Wayne Riggins | Ophthalmology | 1726 Metromedical Dr, Fayetteville, NC 28304-3861 | 2006-05-16 |
| 1164473468 | Kellye A Smith | Ophthalmology | 594 E Millsap Rd, Fayetteville, AR 72703-4096 | 2006-05-12 |
| 1639136229 | Shelby A Stephenson | Ophthalmology | 1629 Owen Dr, Fayetteville, NC 28304-3425 | 2006-04-27 |
| 1760446181 | Brian D Long | Ophthalmology | 340 Brandywine Blvd, Fayetteville, GA 30214-1562 | 2006-04-13 |
| 1891757399 | Steven D. Vold | Ophthalmology | 2783 N Shiloh Dr, Fayetteville, AR 72704-6983 | 2006-04-03 |
| 1851395602 | George Leonard Cooper | Ophthalmology | 2139 Valleygate Dr, Ste 101a, Fayetteville, NC 28304-3666 | 2005-06-09 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on FAYETTE MEDICAL CLINIC OPTICAL SHOP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.