Enchanted Mountain Optometry,PLLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

T005716 Issued in NY

Legal business name

ENCHANTED MOUNTAIN OPTOMETRY,PLLC

Practice address

912 W State St
Olean, NY 14760-2242

Phone

(716) 373-0766

NPI assigned

Nov 10, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Tracy L Ludden, ODNPI 1104916246

Title

Optometrist

Phone

(716) 373-0766

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Enchanted Mountain Eyecare Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tracy Lynn Ludden, OD

  • Optometrist
  • Olean, NY
  • NPI 1104916246
  Medicare reassignment NPD Authorized official
• Stuart P Creson, O.D.

  • Optometrist
  • Greenville, SC
  • NPI 1730110537
  NPD (past)

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

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1013294685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 W STATE ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147602242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 W STATE ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147602242",
            "telephone_number": "716-373-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCHANTED MOUNTAIN OPTOMETRY,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-10",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "LUDDEN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "716-373-0766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "T005716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01608566",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enchanted Mountain Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hussein Elattar, MD
• Madeline Evelyn Elliott, MS, OTR/L
• Richard Bryant Elliott, PT
• Julie A Elsigan, PA-C
• Emergency Medicine Physicians of Cattaraugus County, PLLC
• Erie County South East Corp V
• Jesse Ryan Ernewein, COTA/L
• Sydney Evans
• Exigence Hospitalist Medical Services of Olean, PLLC
• Exigence Medical of Olean, PLLC

• Eyewear Supplier in Olean, NY
• Providers in Olean, NY by specialty
• Eyewear Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; 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.