NPIMap

Organization Active NPI

Gracie Chase Avery, LLC

  • Optometrist
  • Joplin, MO
National Provider Identifier
1003320607
Registry record updated Oct 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T03487 Issued in MO
Legal business name
GRACIE CHASE AVERY, LLC
Practice address
1701 W 26TH St Ste E
Joplin, MO 64804-1513
Phone
(417) 925-2366
Fax
(417) 925-2367
NPI assigned
Nov 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2020

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

Authorized official

Name
Dr. Kevin Michael Gardner, ODNPI 1346358769
Title
Owner
Phone
(417) 499-7715

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
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X T03487 MO Primary

Addresses

Primary practice location

1701 W 26TH St Ste E
Joplin, MO 64804-1513

Mailing address

1701 W 26TH St Ste E
Joplin, MO 64804-1513
Phone (417) 925-2366

Other practice location 1

5265 South Business 71
Suite B3
Pineville, MO 64856
Phone (417) 223-3937

Other names 1

  • 4States Vision Express Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171109003472 MO Part B Supplier - Clinic/Group Practice 7810253663 Receives reassigned benefits from 3 practitioners
Practice locations: Joplin, MO; Pineville, MO
O20210722003919 KS Part B Supplier - Clinic/Group Practice 7810253663 Receives reassigned benefits from 3 practitioners
Practice locations: Pittsburg, KS

National Provider Directory

National Provider Directory

Locations

1701 W 26th St
#E
Joplin, MO 64804
Phone (417) 925-2366

1701 W 26th St
Joplin, MO 64804
Phone (417) 952-2366

114 W Main St
Neosho, MO 64850
Phone (417) 223-3937

5265 S Business Highway 71
Ste B
Pineville, MO 64856

Practitioners & affiliated clinicians

Practitioners 8

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": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602806400000",
    "number": "1003320607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 W 26TH ST STE E",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041513",
            "telephone_number": "417-925-2366",
            "fax_number": "417-925-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 W 26TH ST STE E",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041513",
            "telephone_number": "417-925-2366",
            "fax_number": "417-925-2367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5265 South Business 71",
            "address_2": "Suite B3",
            "address_purpose": "LOCATION",
            "city": "Pineville",
            "state": "MO",
            "postal_code": "64856",
            "country_code": "US",
            "telephone_number": "417-223-3937",
            "fax_number": "417-223-3938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRACIE CHASE AVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-499-7715",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T03487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "4States Vision Express",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.