John Brent Altfillisch, OD
Individual provider Active NPI Optometrist · Ottumwa, IA
NPI 1154420172 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154420172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1537 (IA)
- Practice address
- 224 E Main Street
Ottumwa, IA 52501-2916 - Phone
- (641) 684-5463
- Fax
- (641) 684-5475
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110524000837 | IA | Practitioner - Optometry | 1355333741 |
Reassigns benefits to 2 organizations Practice locations: Clive, IA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1537 | IA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. J. Brent Altfillisch, O.D. P.C. | Optometrist | Current |
Accepting new patients |
| Gulf Coast Optometry, PA | Current |
Accepting new patients | |
| Real Optics Inc | Past | Accepting new patients | |
| National Vision, Inc. | Past |
Accepting new patients | |
| Real Optics Inc | Past | Accepting new patients |
Locations
1725 W Mlk Blvd
Tampa, FL 33607
Phone (239) 800-1717
3750 Gunn Hwy
Ste 108
Tampa, FL 33618
Phone (954) 342-0982
6351 SE 14th St
Des Moines, IA 50320
Phone (515) 953-2020
224 E Main St
#54000
Ottumwa, IA 52501
Phone (515) 684-5463
224 E Main St
Ottumwa, IA 52501
Phone (641) 684-5463
Interoperability endpoints
- jbrentaltfillisch@direct.revolutionehr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1537 | IA | Yes |
Addresses
Primary practice location
224 E Main Street
Ottumwa, IA 52501-2916
Mailing address
PO Box 994
224 E Main Street
Ottumwa, IA 52501-2916
Phone (641) 684-5463
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0098848 | Medicaid | IA |
Other providers in Ottumwa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.