Individual provider Active NPI

Stephen Parker, OD

  • Optometrist
  • Springfield, VA
National Provider Identifier
1154403913
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0601800395 Issued in VA
Practice address
6636 Springfield Mall
Springfield, VA 22150-1712
Phone
(703) 922-4111
Fax
(703) 924-0610
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0601800395 VA Primary

Addresses

Primary practice location

6636 Springfield Mall
Springfield, VA 22150-1712

Mailing address

11103 West Ave
Suite 6
San Antonio, TX 78213-1370
Phone (210) 524-6509

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080822000041 DC Practitioner - Optometry 7618906629 Reassigns benefits to 1 organization
I20250909001238 VA Practitioner - Optometry 7618906629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

19100 Ridgewood Pkwy
San Antonio, TX 78259-1828

19100 Ridgewood Pkwy
BLDG 1 7TH Floor
San Antonio, TX 78259-0001

2863 Lawrence Dr
Falls Church, VA 22042-1403

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0601800395VAMDOptometrist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154403913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "address_2": "SUITE 6",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131370",
            "telephone_number": "210-524-6509",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6636 SPRINGFIELD MALL",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221501712",
            "telephone_number": "703-922-4111",
            "fax_number": "703-924-0610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "STEPHEN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0601800395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, VA

Sources for this page

Verify at the official NPI Registry.