Tyler Wayne Mathenia

Primary specialty

OptometristTaxonomy code 152W00000X

License

2023021529 Issued in MO

Practice address

514 Warrenton County Center
Warrenton, MO 63383

Phone

(636) 377-2054

Fax

(636) 377-2056

NPI assigned

Jun 23, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tylermathenia@direct.eyecare-partners.com

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.

• Clarkson Optometry, Inc

  • Optometrist
  • Ellisville, MO
  • NPI 1497155345
  Medicare reassignment Care Compare group NPD
• Clarkson Optometry Inc

  • Optometrist
  • Elk River, MN
  • NPI 1952992976
  NPD
• Clarkson Eyecare

  • Optometrist
  • Eureka, MO
  • NPI 1205817731
  NPD (past)

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1033895131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207158",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207158",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 WARRENTON COUNTY CENTER",
            "city": "WARRENTON",
            "state": "MO",
            "postal_code": "63383",
            "telephone_number": "636-377-2054",
            "fax_number": "636-377-2056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2121 Zumbehl Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Charles",
            "state": "MO",
            "postal_code": "633032724",
            "country_code": "US",
            "telephone_number": "636-949-2906",
            "fax_number": "636-949-2914",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2946 Highway K",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "MO",
            "postal_code": "633687861",
            "country_code": "US",
            "telephone_number": "636-240-1516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "933 Highway K",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "MO",
            "postal_code": "633662910",
            "country_code": "US",
            "telephone_number": "636-379-4288",
            "fax_number": "636-272-2765",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "83 The Plz",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MO",
            "postal_code": "633791365",
            "country_code": "US",
            "telephone_number": "636-462-3958",
            "fax_number": "636-462-3957",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "390 Mid Rivers Mall Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633761565",
            "country_code": "US",
            "telephone_number": "636-279-2020",
            "fax_number": "636-279-1055",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "230 N Lindbergh Blvd",
            "address_purpose": "LOCATION",
            "city": "Florissant",
            "state": "MO",
            "postal_code": "630315904",
            "country_code": "US",
            "telephone_number": "314-921-9377",
            "fax_number": "314-830-2940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1894 Wentzville Pkwy",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633853820",
            "country_code": "US",
            "telephone_number": "636-887-4000",
            "fax_number": "636-887-4095",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6313 Ronald Reagan Dr",
            "address_purpose": "LOCATION",
            "city": "Lake St Louis",
            "state": "MO",
            "postal_code": "633672681",
            "country_code": "US",
            "telephone_number": "636-561-2342",
            "fax_number": "636-561-2362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHENIA",
        "first_name": "TYLER",
        "middle_name": "WAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2023021529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Renee Leone, FNP-C
• Lifenet, Inc
• Kara Lippmann, COTA/L
• John Lusicic, DC
• Dawn Marquart, RDH
• Jay L Maturan, ATC, MAT, LAT
• Beth Maynard
• Cori McIntire, BCBA, LBA
• Jennifer Michelle McQuaide, LPC
• McWilliams Eyecare, LLC

• Optometrist in Warrenton, MO
• Providers in Warrenton, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.