Active NPI
Roger Marvin Allyn, O.D.
- Optometrist
- La Plata, NM
National Provider Identifier
1093979874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2219 OP
- Practice address
- 1170 Hwy 170
La Plata, NM 87418-0269 - Phone
- (505) 325-2472
- NPI assigned
- Jul 11, 2008
- Last updated
- Jul 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2219 OP | NM | Primary |
Addresses
Primary practice location
1170 Hwy 170
La Plata, NM 87418-0269
Mailing address
PO Box 269
La Plata, NM 87418-0269
Phone (505) 325-2472
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2219 OP | NM | MD | Optometrist |
Practice roles
Organizations & group practices 21
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Clinic/Center
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- NPI 1174683825
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- Clinic/Center
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- NPI 1285796870
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- Clinic/Center
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- NPI 1366502767
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- Clinic/Center
- South Naknek, AK
- NPI 1417018193
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- Clinic/Center
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- NPI 1487716825
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- Clinic/Center
- Perryville, AK
- NPI 1528128782
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- Clinic/Center
- Chignik Lagoon, AK
- NPI 1578623641
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- Clinic/Center
- Egegik, AK
- NPI 1699836007
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215734400000",
"number": "1093979874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 269",
"city": "LA PLATA",
"state": "NM",
"postal_code": "874180269",
"telephone_number": "505-325-2472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1170 HWY 170",
"city": "LA PLATA",
"state": "NM",
"postal_code": "874180269",
"telephone_number": "505-325-2472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLYN",
"first_name": "ROGER",
"middle_name": "MARVIN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-11",
"last_updated": "2008-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NM",
"license": "2219 OP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Plata, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.