Individual provider Active NPI

Kathryn K Clair, O.D.

  • Optometrist
  • Shenandoah, TX
National Provider Identifier
1063662716
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7321T Issued in TX
Practice address
22 Delmar Green PL
Shenandoah, TX 77381-2994
Phone
(918) 822-0272
NPI assigned
Sep 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7321T TX Primary

Addresses

Primary practice location

22 Delmar Green PL
Shenandoah, TX 77381-2994

Mailing address

22 Delmar Green PL
Shenandoah, TX 77381-2994
Phone (918) 822-0272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100714000805 TX Practitioner - Optometry 0547392375 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7321TXMDProfessional Counselor
7321TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Doreck Vision, LLC Optometrist CurrentSince Feb 6, 2023 Accepting new patients
Wagnertc P C Optometrist PastSince Oct 18, 2018 Accepting new patients

Locations

12709 Interstate 45 N
Ste 500
Willis, TX 77318
Phone (936) 856-9400

Organizations & group practices 2

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": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365638400000",
    "number": "1063662716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 DELMAR GREEN PL",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773812994",
            "telephone_number": "918-822-0272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 DELMAR GREEN PL",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773812994",
            "telephone_number": "918-822-0272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAIR",
        "first_name": "KATHRYN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2013-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7321T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, TX

Sources for this page

Verify at the official NPI Registry.