Individual provider Active NPI

Reena Ann Lepine, OD

  • Optometrist
  • Memphis, TN
National Provider Identifier
1194004085
Registry record updated Aug 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1616-649T Issued in LA
Practice address
1225 Madison Ave
Memphis, TN 38104-2211
Phone
(901) 722-3250
Fax
(901) 722-3347
NPI assigned
Aug 9, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1616-649T LA Primary

Addresses

Primary practice location

1225 Madison Ave
Memphis, TN 38104-2211

Mailing address

1245 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3250

Other identifiers 2

IdentifierTypeStateIssuer
2159861MedicaidLA
07759297MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20130830000704 TN Practitioner - Optometry 4587835947 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3132TNMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern College of Optometry Optometrist CurrentSince Jul 19, 2013 Accepting new patients

Locations

1245 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250

1225 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250

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": "1312848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376611200000",
    "number": "1194004085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042211",
            "telephone_number": "901-722-3250",
            "fax_number": "901-722-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042211",
            "telephone_number": "901-722-3250",
            "fax_number": "901-722-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEPINE",
        "first_name": "REENA",
        "middle_name": "ANN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-09",
        "last_updated": "2013-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1616-649T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2159861",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07759297",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.