Ryan Kyle Petty, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003259A Issued in IN

Practice address

488 W Hospital Rd
Paoli, IN 47454-8807

Phone

(812) 723-4752

Fax

(812) 723-4753

NPI assigned

Mar 9, 2006

Last updated

Dec 11, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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 1

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 LLCGroup PAC ID 0840505285, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Indiana Eye Care, LLC

  • Optometrist
  • Paoli, IN
  • NPI 1720475965
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197331200000",
    "number": "1174591960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "488 W HOSPITAL RD",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474548807",
            "telephone_number": "812-723-4752",
            "fax_number": "812-723-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "488 W HOSPITAL RD",
            "city": "PAOLI",
            "state": "IN",
            "postal_code": "474548807",
            "telephone_number": "812-723-4752",
            "fax_number": "812-723-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "RYAN",
        "middle_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2007-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003259A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Orange County Health Dept
• Paoli Community School Corporation
• Brenda J Pardy, BS
• Glenn Jay Pedersen, D.C.
• Personal Counseling LLC
• Kathryn Poole
• Jason Paul Price
• Lynette Price
• Gabriela Amairany Ramirez, LMSW
• Jasmita Ranchod, LSW

• Optometrist in Paoli, IN
• Providers in Paoli, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.