Individual provider Active NPI

Carly Ann Gentry, OD

  • Optometrist
  • Schertz, TX
National Provider Identifier
1205357951
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9238T Issued in TX
Practice address
17323 Ih 35 N Ste 110
Schertz, TX 78154-1278
Phone
(210) 651-5800
NPI assigned
Jul 3, 2017
Last updated
Mar 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9238T TX Primary

Addresses

Primary practice location

17323 Ih 35 N Ste 110
Schertz, TX 78154-1278

Mailing address

10413 Aurora Sky
Schertz, TX 78154-3478

Other practice location 1

2530 Marshall Rd
San Antonio, TX 78259-1608
Phone (210) 590-1302

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20181218001468 TX Practitioner - Optometry 5395080477 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michelle Buttlar OD PCGroup PAC ID 5698758795, 3 clinicians

Practice addresses (Care Compare)

17323 Ih 35
Suite 110
Schertz, TX 78154-1278
Phone (210) 651-5800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9238TXMDBehavioral Analyst
9238TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michelle Buttlar, OD, PC Optometrist CurrentSince Jun 1, 2021 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1205357951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10413 AURORA SKY",
            "city": "SCHERTZ",
            "state": "TX",
            "postal_code": "781543478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17323 IH 35 N STE 110",
            "city": "SCHERTZ",
            "state": "TX",
            "postal_code": "781541278",
            "telephone_number": "210-651-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2530 Marshall Rd",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782591608",
            "country_code": "US",
            "telephone_number": "210-590-1302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GENTRY",
        "first_name": "CARLY",
        "middle_name": "ANN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-03",
        "last_updated": "2021-03-10",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9238T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Schertz, TX

Sources for this page

Verify at the official NPI Registry.