Kilgore-Gilmer Eye Care Centers P.a.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2344TG Issued in TX

Legal business name

KILGORE-GILMER EYE CARE CENTERS P.A.

Doing business as

Kilgore Eye Care Center

Practice address

1100 Stone Rd
Suite 2020
Kilgore, TX 75662-5482

Phone

(903) 983-2020

Fax

(903) 983-4000

NPI assigned

Jul 5, 2006

Last updated

Sep 25, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Ted Roberts, O.D.NPI 1629032768

Title

Owner

Phone

(903) 983-2020

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Kilgore Eye Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Kilgore-Gilmer-Eye Care Centers P.a.

  dba Gilmer Eye Care Center

  • Optometrist
  • Gilmer, TX
  • NPI 1104335918
  NPPES parent name

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jerry Ted Roberts, O.D.

  • Corneal and Contact Management Optometrist
  • Kilgore, TX
  • NPI 1629032768
  Medicare reassignment Care Compare group NPD Authorized official
• Jadie Bolton Roberts, OD

  • Optometrist
  • Kilgore, TX
  • NPI 1952593311
  Medicare reassignment Care Compare group NPD
• Shiloh Suzanne Roberts, O.D.

  • Optometrist
  • Gilmer, TX
  • NPI 1427240878
  Medicare reassignment Care Compare group NPD
• Shawn Kenneth Johnston, OD

  • Optometrist
  • Gilmer, TX
  • NPI 1952754202
  Medicare reassignment Care Compare group
• Alexander Joseph Reed, O.D.

  • Optometrist
  • Ardmore, OK
  • NPI 1427499227
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506297600000",
    "number": "1184655649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8000",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756638000",
            "telephone_number": "903-983-2020",
            "fax_number": "903-983-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 STONE RD",
            "address_2": "SUITE 2020",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756625482",
            "telephone_number": "903-983-2020",
            "fax_number": "903-983-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILGORE-GILMER EYE CARE CENTERS P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2017-09-25",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "TED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-983-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2344TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019369001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00E45Y",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA-RAILROAD MED",
            "identifier": "410022897",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kilgore Eye Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kilgore Independent School District
• Kilgore Integrated Health PLLC
• Kilgore Life Center
• Kilgore Manor Inc (Legacy Living Centers)
• Kilgore Spine and Joint PLLC
• Austin Knox, LPC ASSOCIATE
• Angela Solis Krenek, RPH
• Cynthia Kulak, P.T.
• Kulkarni Dental PC (deluxe dental)
• Colleen S. Lagrone, MPT

• Optometrist in Kilgore, TX
• Providers in Kilgore, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.