Ryan Kyle Petty, O.D.
Individual provider Active NPI Optometrist · Paoli, IN
NPI 1174591960 · NPPES record last updated Dec 11, 2007
Key facts
- NPI
- 1174591960
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 18003259A (IN)
- Practice address
- 488 W Hospital Rd
Paoli, IN 47454-8807 - Phone
- (812) 723-4752
- Fax
- (812) 723-4753
- NPI assigned
- Mar 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern Indiana Eye Care LLC
Practice addresses (Care Compare)
921 W Hospital Rd
Paoli, IN 47454-9668
Phone (812) 723-4752
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 101 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20110126000898 | IN | Practitioner - Optometry | 5597944231 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18003259A | IN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Indiana Eye Care, LLC | Optometrist | Current |
Accepting new patients |
Locations
921 W Hospital Rd
Paoli, IN 47454
Phone (812) 723-2255
488 W Hospital Rd
Paoli, IN 47454
Phone (812) 723-4301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18003259A | IN | Yes |
Addresses
Primary practice location
488 W Hospital Rd
Paoli, IN 47454-8807
Mailing address
488 W Hospital Rd
Paoli, IN 47454-8807
Phone (812) 723-4752
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200460220A | Medicaid | IN |
Other providers in Paoli, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.