Shawnee Eye Associates, PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2690 Issued in OK

Legal business name

SHAWNEE EYE ASSOCIATES, PLLC

Doing business as

Shawnee Vision Source

Practice address

100 E 45TH St
Shawnee, OK 74804-1439

Phone

(405) 275-7676

Fax

(405) 275-6837

NPI assigned

Sep 22, 2014

Last updated

Sep 22, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Trevor Conklin, MDNPI 1649558321

Title

Owner/Partner

Phone

(405) 275-7676

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shawnee Vision Source Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: badams13@visionsourceshawnee.eyefinity-direct.com
• Direct secure messaging: bweber@visionsourceshawnee.eyefinity-direct.com
• Direct secure messaging: kkarnish@visionsourceshawnee.eyefinity-direct.com
• Direct secure messaging: kliewer@visionsourceshawnee.eyefinity-direct.com
• Direct secure messaging: tconklin@visionsourceshawnee.eyefinity-direct.com

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Trevor C Conklin, O.D.

  • Optometrist
  • Oklahoma City, OK
  • NPI 1649558321
  Medicare reassignment Care Compare group Authorized official
• Kyle Karnish, O.D.

  • Optometrist
  • Tecumseh, OK
  • NPI 1912285750
  Medicare reassignment Care Compare group NPD
• Travis Ryan Kliewer, O.D.

  • Optometrist
  • Shawnee, OK
  • NPI 1629324595
  Medicare reassignment Care Compare group NPD
• Brianna Weber, OD

  • Optometrist
  • Shawnee, OK
  • NPI 1326622036
  Medicare reassignment Care Compare group NPD
• Britton Adams, OD

  • Optometrist
  • Shawnee, OK
  • NPI 1447737960
  Medicare reassignment NPD

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411344000000",
    "number": "1104228105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 45TH ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041439",
            "telephone_number": "405-275-7676",
            "fax_number": "405-275-6837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 45TH ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041439",
            "telephone_number": "405-275-7676",
            "fax_number": "405-275-6837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE EYE ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-22",
        "last_updated": "2014-09-22",
        "status": "A",
        "authorized_official_last_name": "CONKLIN",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "405-275-7676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200350320A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shawnee Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deborah L Sharp
• Shawnee Care Center LLC (Shawnee Care Center)
• Shawnee Dental, PLLC
• Shawnee Dentistry and Braces
• Shawnee Discount Drug
• Shawnee Heart Center Inc
• Shawnee Medical Center Clinic, Inc (SSM Health Medical Group Shawnee Ortho)
• Shawnee Medical Center Clinic, Inc (SSM Health Shawnee Behavorial Health Clinic)
• Shawnee Medical Center Clinic, Inc (SSM Health Radiation Oncology Shawnee)
• Shawnee MRI Associates, L.L.C. (Shawnee Open MRI)

• Optometrist in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.