NPIMap

Individual provider Active NPI

Sara L Pourheydarian, O.D.

  • Optometrist
  • Louisville, KY
National Provider Identifier
1033464458
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1906DT Issued in KY
Practice address
4000 Poplar Level Rd
Louisville, KY 40213-1524
Phone
(502) 459-2020
Fax
(502) 456-9121
NPI assigned
Jul 23, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1906DT KY Primary
Optometrist 152W00000X 18003756A IN

Addresses

Primary practice location

4000 Poplar Level Rd
Louisville, KY 40213-1524

Mailing address

4000 Poplar Level Rd
Louisville, KY 40213-1524
Phone (502) 459-2020

Other identifiers 2

IdentifierTypeStateIssuer
1906DTOtherKYKY LICENSE
7100227860MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121026000203 KY Practitioner - Optometry 4082864186 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Louisville Optometric Centers III, PSCGroup PAC ID 8729041926, 38 clinicians

Practice addresses (Care Compare)

1627 Midland TRL
Shelbyville, KY 40065-1638
Phone (502) 633-2985

4000 Poplar Level Rd
Louisville, KY 40213-1524
Phone (502) 459-2020

4202 Polar Level Rd
Louisville, KY 40213-1524
Phone (502) 459-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18003756AINMDOptometrist
1906DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Louisville Optometric Centers III, PSC CurrentSince Feb 17, 2015 Accepting new patients
Louisville Optometric Centers III, PSC Optometrist CurrentSince Feb 17, 2015 Accepting new patients
Louisville Optometric Centers, III PSC Optometrist Past Accepting new patients

Locations

315 Leonardwood Rd
Frankfort, KY 40601
Phone (502) 223-2314

4202 Poplar Level Rd
Louisville, KY 40213

4000 Poplar Level Rd
Louisville, KY 40213
Phone (502) 456-1004

1627 Midland Trl
Shelbyville, KY 40065
Phone (502) 633-2985

Organizations & group practices 20

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1033464458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 POPLAR LEVEL RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131524",
            "telephone_number": "502-459-2020",
            "fax_number": "502-456-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 POPLAR LEVEL RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131524",
            "telephone_number": "502-459-2020",
            "fax_number": "502-456-9121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POURHEYDARIAN",
        "first_name": "SARA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-23",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1906DT",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003756A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY LICENSE",
            "identifier": "1906DT",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100227860",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.