Basic Information
Provider Information | |||||||||
NPI: | 1295733426 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | POPE | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1040 RANDOLPH ST | ||||||||
Address2: | SUITE 32 | ||||||||
City: | THOMASVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 273606383 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3364750143 | ||||||||
FaxNumber: | 3364726831 | ||||||||
Practice Location | |||||||||
Address1: | 1033 RANDOLPH ST STE 4 | ||||||||
Address2: |   | ||||||||
City: | THOMASVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 273605731 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3364750151 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2005 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1023 | NC | Y |   | Eye and Vision Services Providers | Optometrist |   |
ID Information
ID | Type | State | Issuer | Description | 037737001 | 01 | NC | PALMETTO-DMERC-MEDICARE | OTHER | 09720 | 01 | NC | BCBS | OTHER | 5913114 | 05 | NC |   | MEDICAID |