Individual provider Active NPI

Shari Ann Selander-Storm, O.D.

  • Optometrist
  • Davenport, IA
National Provider Identifier
1043332059
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
I15328 Issued in IA
Practice address
4310 E 53Rd St
Davenport, IA 52807-3039
Phone
(563) 324-2020
NPI assigned
Apr 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046-008550 IL
Optometrist 152W00000X I15328 IA Primary

Addresses

Primary practice location

4310 E 53Rd St
Davenport, IA 52807-3039

Mailing address

4310 E 53Rd St
Davenport, IA 52807-3039
Phone (563) 324-2020

Other practice location 1

4703 16th St
Moline, IL 61265-7066
Phone (309) 762-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20140519001426 IA Practitioner - Optometry 4082837125 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Care Pavilion PLCGroup PAC ID 2062460843, 4 clinicians

Practice addresses (Care Compare)

4310 E 53Rd St
Davenport, IA 52807-3039
Phone (563) 324-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I15328IAMDOptometrist
046-008550ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Care Pavilion PLC Optometrist CurrentSince Jul 1, 2014 Accepting new patients

Locations

4310 E 53rd St
Davenport, IA 52807
Phone (563) 322-1158

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1043332059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 E 53RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073039",
            "telephone_number": "563-324-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 E 53RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073039",
            "telephone_number": "563-324-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4703 16th St",
            "address_purpose": "LOCATION",
            "city": "Moline",
            "state": "IL",
            "postal_code": "612657066",
            "country_code": "US",
            "telephone_number": "309-762-3937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SELANDER-STORM",
        "first_name": "SHARI",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008550",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "I15328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.