McCaulley Optometric PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

1198-3 Issued in KS

Legal business name

MCCAULLEY OPTOMETRIC PA

Practice address

2601 10TH St
Great Bend, KS 67530-4253

Phone

(620) 792-2020

Fax

(620) 792-2583

NPI assigned

Jun 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Russell L McCaulley, O.D.NPI 1861463341

Title

Owner

Phone

(620) 792-2020

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• The 10th Street Eyecare Center Doing business as

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• The Russell Eyecare Center

  • Optometrist
  • Russell, KS
  • NPI 1841710563

  Member Of

  NPD member

Locations

Practitioners 5

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

• Russell L McCaulley, O.D.

  • Optometrist
  • Great Bend, KS
  • NPI 1861463341

  KS, Optometrist

  Medicare reassignment Care Compare group NPD Authorized official
• Nicole Renee Miller, O.D.

  • Optometrist
  • Great Bend, KS
  • NPI 1700225299

  KS, Optometrist

  Medicare reassignment Care Compare group NPD
• Chad T Premer, O.D.

  • Optometrist
  • Great Bend, KS
  • NPI 1104897677

  KS, Optometrist

  Medicare reassignment Care Compare group NPD
• Sarah Lynn Stueder, OD

  • Optometrist
  • Great Bend, KS
  • NPI 1073033064

  KS, Optometrist

  Medicare reassignment Care Compare group NPD
• Bridgette Anne Ostmeyer, O.D

  • Optometrist
  • Topeka, KS
  • NPI 1821079294
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1043255243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 10TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675304253",
            "telephone_number": "620-792-2020",
            "fax_number": "620-792-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 10TH ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675304253",
            "telephone_number": "620-792-2020",
            "fax_number": "620-792-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCAULLEY OPTOMETRIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "MCCAULLEY",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "620-792-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1198-3",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1692",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100213630A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "005344",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MC GROUP NUMBER",
            "identifier": "020075001",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The 10th Street Eyecare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charlotta A Matson, RN
• Amanda Matzke, SLP
• Jayme Lynn Mayers, PT
• Reed Allan McAtee, OD
• Ellanor Ruth McCall, LAC
• Russell L McCaulley, O.D.
• Julie Kay McClaren, ARNP
• Clarissa McCormick
• Meagen McDonald
• Earl W McGee, LSCSW BCD

• All providers in Great Bend, KS
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.