NPIMap

Organization Active NPI

Jacob G. Despain OD PC

  • Optometrist
  • Cody, WY
National Provider Identifier
1104237601
Registry record updated May 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
327T Issued in WY
Legal business name
JACOB G. DESPAIN OD PC
Practice address
1708 Stampede Ave
Cody, WY 82414-4829
Phone
(307) 587-2404
Fax
(307) 527-7368
NPI assigned
May 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2014

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

Authorized official

Name
Dr. Jacob G Despain, O.D.NPI 1124284997
Title
Optometrist
Phone
(307) 587-2404

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 327T WY Primary

Addresses

Primary practice location

1708 Stampede Ave
Cody, WY 82414-4829

Mailing address

1708 Stampede Ave
Cody, WY 82414-4829
Phone (307) 587-2404

Other names 1

  • Family Vision Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140722001917 WY Part B Supplier - Clinic/Group Practice 4587880869 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Lovell, WY; Cody, WY
O20141117001344 WY DME Supplier - Physician - Optometrist 4587880869 Practice locations: Cody, WY

National Provider Directory

National Provider Directory
Tax ID family
Family Vision Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400457600000",
    "number": "1104237601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 STAMPEDE AVE",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824144829",
            "telephone_number": "307-587-2404",
            "fax_number": "307-527-7368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 STAMPEDE AVE",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824144829",
            "telephone_number": "307-587-2404",
            "fax_number": "307-527-7368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB G. DESPAIN OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-19",
        "last_updated": "2014-05-19",
        "status": "A",
        "authorized_official_last_name": "DESPAIN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "307-587-2404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WY",
            "license": "327T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cody, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.