NPIMap

Organization Active NPI

Ettinger Optometry, LLC

  • Corneal and Contact Management Optometrist
  • Fort Leonard Wood, MO
National Provider Identifier
1003263096
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
T02543 Issued in MO
Legal business name
ETTINGER OPTOMETRY, LLC
Practice address
143 Replacement Ave
Building 487
Fort Leonard Wood, MO 65473-9092
Phone
(573) 329-4860
Fax
(573) 329-4860
NPI assigned
May 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Dr. Ira Nathan Ettinger, OD
Title
Optometrist
Phone
(314) 420-7031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WC0802X T02543 MO Primary

Addresses

Primary practice location

143 Replacement Ave
Building 487
Fort Leonard Wood, MO 65473-9092

Mailing address

143 Replacement Ave
Building 487
Fort Leonard Wood, MO 65473-9092
Phone (573) 329-4860

National Provider Directory

National Provider Directory

Locations

143 Replacement Ave
Bldg 487
Fort Leonard Wood, MO 65473
Phone (573) 329-0130

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1003263096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 REPLACEMENT AVE",
            "address_2": "BUILDING 487",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739092",
            "telephone_number": "573-329-4860",
            "fax_number": "573-329-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 REPLACEMENT AVE",
            "address_2": "BUILDING 487",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739092",
            "telephone_number": "573-329-4860",
            "fax_number": "573-329-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETTINGER OPTOMETRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-19",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "ETTINGER",
        "authorized_official_first_name": "IRA",
        "authorized_official_middle_name": "NATHAN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "314-420-7031",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MO",
            "license": "T02543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Leonard Wood, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; 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.