Individual provider Active NPI

Jaclyn May Wray, O.D.

  • Optometrist
  • Longmont, CO
National Provider Identifier
1194089060
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2918 Issued in CO
Practice address
2080 Main St
Longmont, CO 80501-1916
Phone
(303) 651-2020
NPI assigned
Jun 26, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2918 CO Primary

Addresses

Primary practice location

2080 Main St
Longmont, CO 80501-1916

Mailing address

2832 Sage Creek Rd
Fort Collins, CO 80528-3105
Phone (510) 292-8101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20121005000430 CO Practitioner - Optometry 4385893312 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optometric Associates PCGroup PAC ID 0345131033, 6 clinicians

Practice addresses (Care Compare)

2080 Main St
Longmont, CO 80501-1916
Phone (303) 772-2755

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2918COMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Optometric Associates PC Optometrist CurrentSince Aug 1, 2013 Accepting new patients

Locations

2080 Main St
Longmont, CO 80501
Phone (303) 651-2020

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": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477267200000",
    "number": "1194089060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2832 SAGE CREEK RD",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283105",
            "telephone_number": "510-292-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 MAIN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805011916",
            "telephone_number": "303-651-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRAY",
        "first_name": "JACLYN",
        "middle_name": "MAY",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2016-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.