Active NPI
Jeffrey Shane Osborne, O.D.
- Optometrist
- Pikeville, KY
National Provider Identifier
1003960634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1230-DT
- Practice address
- 3469 N. Mayo Trail
Pikeville, KY 41501 - Phone
- (606) 437-7702
- Fax
- (606) 437-2307
- NPI assigned
- Jan 22, 2007
- Last updated
- Mar 4, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1230-DT | KY | Primary |
| Low Vision Rehabilitation Optometrist | 152WL0500X | 1230- DT | KY |
Addresses
Primary practice location
3469 N. Mayo Trail
Pikeville, KY 41501
Mailing address
3469 Morth Mayo Trail
Pikeville, KY 41501
Phone (606) 437-7702
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77012300 | Medicaid | KY | |
| 1003960634 | Medicaid | KY |
Other names 1
- J. Shane Osborne
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1230-DT | KY | MD | Optometrist |
| 1230- DT | KY | MD | Low Vision Rehabilitation Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236124800000",
"number": "1003960634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3469 MORTH MAYO TRAIL",
"city": "PIKEVILLE",
"state": "KY",
"postal_code": "41501",
"telephone_number": "606-437-7702",
"fax_number": "606-437-2307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3469 N. MAYO TRAIL",
"city": "PIKEVILLE",
"state": "KY",
"postal_code": "41501",
"telephone_number": "606-437-7702",
"fax_number": "606-437-2307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OSBORNE",
"first_name": "JEFFREY",
"middle_name": "SHANE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2009-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KY",
"license": "1230-DT",
"primary": true
},
{
"code": "152WL0500X",
"taxonomy_group": "",
"desc": "Optometrist, Low Vision Rehabilitation",
"state": "KY",
"license": "1230- DT",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77012300",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1003960634",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "J. SHANE",
"last_name": "OSBORNE",
"credential": "O.D.",
"code": "2",
"type": "Professional Name"
}
]
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- Monica Louise Owens, MS, RD, LD
- Stacey Denise Owens, HYPNOTHERAPIST
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.