Organization Active NPI

Fry Eye Associates PA

  • Ophthalmology Physician
  • Garden City, KS
National Provider Identifier
1124049499
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
FRY EYE ASSOCIATES PA
Practice address
502 College Street
Garden City, KS 67846-6183
Phone
(620) 275-7248
Fax
(620) 275-5262
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Authorized official

Name
Jennifer Teeter
Title
Practice Administrator
Phone
(620) 275-7248

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

502 College Street
Garden City, KS 67846-6183

Mailing address

502 College Street
Garden City, KS 67846-6183
Phone (620) 275-7248

Other identifiers 3

IdentifierTypeStateIssuer
100722450AMedicaidOK
94001922MedicaidCO
100215250AMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050228000731 KS Part B Supplier - Clinic/Group Practice 7012960289 Receives reassigned benefits from 4 practitioners
Practice locations: Garden City, KS
O20110404000861 CO Part B Supplier - Clinic/Group Practice 7012960289 Receives reassigned benefits from 2 practitioners
Practice locations: Lamar, CO

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
17D1038365Fry Eye Associates, PA502 College Street, Garden City, KS 67846Certificate of waiverMar 16, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1607 S Main St
Lamar, CO 81052
Phone (620) 275-7248

1005 S Range Ave
Colby, KS 67701

310 E Walnut St
Ste 101
Garden City, KS 67846
Phone (620) 275-7248

11 W Parkway Blvd
Liberal, KS 67901
Phone (620) 624-0142

Practitioners & affiliated clinicians

Practitioners 4

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": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1124049499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 COLLEGE STREET",
            "city": "GARDEN CITY",
            "state": "KS",
            "postal_code": "678466183",
            "telephone_number": "620-275-7248",
            "fax_number": "620-275-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 COLLEGE STREET",
            "city": "GARDEN CITY",
            "state": "KS",
            "postal_code": "678466183",
            "telephone_number": "620-275-7248",
            "fax_number": "620-275-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRY EYE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "TEETER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "620-275-7248"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100722450A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94001922",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100215250A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; 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.