NPIMap

Organization Active NPI

Douglas E Ball OD PA

  • Optometrist
  • Hutchinson, KS
National Provider Identifier
1124021084
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DOUGLAS E BALL OD PA
Practice address
3120 N Plum St
Hutchinson, KS 67502-2918
Phone
(620) 662-2355
Fax
(620) 662-1102
NPI assigned
May 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Authorized official

Name
Benjamin Lane Whittredge, ODNPI 1407836968
Title
Secretary/Treasurer
Phone
(620) 662-2355

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

3120 N Plum St
Hutchinson, KS 67502-2918

Mailing address

3120 N Plum St
Hutchinson, KS 67502-2918
Phone (620) 662-2355

Other names 1

  • Southwind Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050329001023 KS Part B Supplier - Clinic/Group Practice 9032165444 Receives reassigned benefits from 4 practitioners
Practice locations: Hutchinson, KS
O20100930025377 KS DME Supplier - Physician - Optometrist 9032165444 Practice locations: Hutchinson, KS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2096114Douglas E Ball OD PA3120 N Plum, Hutchinson, KS 67502Certificate of waiverMay 14, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Douglas E. Ball Odpa3120 N Plum St, Hutchinson, KS 67502-2918(620) 662-2355 Ultraviolet Light Devices and/or Supplies|Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1990

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1124021084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 N PLUM ST",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675022918",
            "telephone_number": "620-662-2355",
            "fax_number": "620-662-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 N PLUM ST",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675022918",
            "telephone_number": "620-662-2355",
            "fax_number": "620-662-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS E BALL OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "WHITTREDGE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "LANE",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "620-662-2355",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwind Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hutchinson, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.