Active NPI
Tom W Clyde, OPTOMETRIST
- Optometrist
- Colorado Springs, CO
National Provider Identifier
1104880434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 867
- Practice address
- 710 N Circle Dr
Colorado Springs, CO 80909-5122 - Phone
- (719) 632-1587
- Fax
- (719) 632-1563
- NPI assigned
- Apr 13, 2006
- 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 | 867 | CO | Primary |
Addresses
Primary practice location
710 N Circle Dr
Colorado Springs, CO 80909-5122
Mailing address
710 N Circle Dr
Colorado Springs, CO 80909-5122
Phone (719) 632-1587
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08008674 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458691200000",
"number": "1104880434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 N CIRCLE DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095122",
"telephone_number": "719-632-1587",
"fax_number": "719-632-1563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 N CIRCLE DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095122",
"telephone_number": "719-632-1587",
"fax_number": "719-632-1563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLYDE",
"first_name": "TOM",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "OPTOMETRIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-13",
"last_updated": "2016-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CO",
"license": "867",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08008674",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.