NPIMap

Organization Active NPI

Eye Site

Doing business as The Eyesite of Anthem

  • Optometrist
  • Henderson, NV
National Provider Identifier
1114231081
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
553 Issued in NV
Legal business name
EYE SITE
Doing business as
The Eyesite of Anthem
Practice address
11540 S Eastern Ave Ste 100
Henderson, NV 89052-6449
Phone
(702) 476-2225
Fax
(702) 476-4778
NPI assigned
Aug 3, 2010
Last updated
Nov 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Authorized official

Name
Kenneth C McCandlessNPI 1063426740
Title
Optometrist / Owner
Phone
(702) 476-2225

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
Optometrist 152W00000X 553 NV Primary

Addresses

Primary practice location

11540 S Eastern Ave Ste 100
Henderson, NV 89052-6449

Mailing address

11540 S Eastern Ave Ste 100
Henderson, NV 89052-6449
Phone (702) 476-2225

Other names 1

  • The Eyesite of Anthem Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101109000829 NV Part B Supplier - Clinic/Group Practice 8426953381 Receives reassigned benefits from 2 practitioners
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Locations

7340 Thornton Ave
Newark, CA 94560
Phone (510) 792-9611

11540 S Eastern Ave
Ste 100
Henderson, NV 89052
Phone (702) 476-2225

2505 Anthem Village Dr
#1A
Henderson, NV 89052
Phone (702) 476-2225

2505 Anthem Village Dr
Ste 1A
Henderson, NV 89052

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1114231081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11540 S EASTERN AVE STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890526449",
            "telephone_number": "702-476-2225",
            "fax_number": "702-476-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11540 S EASTERN AVE STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890526449",
            "telephone_number": "702-476-2225",
            "fax_number": "702-476-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SITE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A",
        "authorized_official_last_name": "MCCANDLESS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OPTOMETRIST / OWNER",
        "authorized_official_telephone_number": "702-476-2225"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NV",
            "license": "553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Eyesite of Anthem",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Eyesite of Anthem",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; 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.