Individual provider Active NPI

Chinazo Crystal Ehie, OD

  • Optometrist
  • Lancaster, TX
National Provider Identifier
1093363384
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9817T Issued in TX
Practice address
3200 W Pleasant Run Rd Ste 200
Lancaster, TX 75146-1084
Phone
(469) 747-3027
NPI assigned
Aug 29, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9817T TX Primary

Addresses

Primary practice location

3200 W Pleasant Run Rd Ste 200
Lancaster, TX 75146-1084

Mailing address

3200 W Pleasant Run Rd
Lancaster, TX 75146-1073
Phone (469) 747-3027

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
I20191021003550 TX Practitioner - Optometry 0042542284 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9817TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Staten Island Physician Practice PC PastSince Jul 10, 2019 Accepting new patients

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": "1567036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1093363384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 W PLEASANT RUN RD",
            "city": "LANCASTER",
            "state": "TX",
            "postal_code": "751461073",
            "telephone_number": "469-747-3027",
            "fax_number": "303-800-2078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 W PLEASANT RUN RD STE 200",
            "city": "LANCASTER",
            "state": "TX",
            "postal_code": "751461084",
            "telephone_number": "469-747-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHIE",
        "first_name": "CHINAZO",
        "middle_name": "CRYSTAL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-29",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9817T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, TX

Sources for this page

Verify at the official NPI Registry.