Michael R Montgomery, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

T02552 Issued in MO

Practice address

279 E Elm St
Lebanon, MO 65536-3610

Phone

(417) 532-2562

Fax

(417) 532-2409

NPI assigned

Dec 5, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael Montgomery OD PC

  • Ophthalmology Physician
  • Lebanon, MO
  • NPI 1316078868

  Optometrist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1124002969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 E ELM ST",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363610",
            "telephone_number": "417-532-2562",
            "fax_number": "417-532-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 E ELM ST",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363610",
            "telephone_number": "417-532-2562",
            "fax_number": "417-532-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBC-LEBABON LOCATION",
            "identifier": "117102",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "117105",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA-LEBANON LOCATION",
            "identifier": "12603",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312368319",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Micheal J. Miller, D.C.
• Nakkia Danielle Miller, LPN
• Missouri Behavioral Health Counseling Associates
• Julie Mitchell, LPC
• Philip V. Mitchell, MD
• Charlotte A Moore, LPC
• Morgan Moore, DC
• Ronna Ann Moore, PTA
• Donna Jean Moriarty, RNC, WHNP
• Abigail Nicole Motsinger

• Optometrist in Lebanon, MO
• Providers in Lebanon, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.