Individual provider Active NPI

Tyler Reppert, O.D.

  • Optometrist
  • Willow Street, PA
National Provider Identifier
1215486121
Registry record updated Mar 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG003207 Issued in PA
Practice address
2600 Willow Street Pike N Ste 310
Willow Street, PA 17584-9386
Phone
(717) 947-4843
Fax
(717) 947-4279
NPI assigned
Oct 4, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG003207 PA Primary

Addresses

Primary practice location

2600 Willow Street Pike N Ste 310
Willow Street, PA 17584-9386

Mailing address

2600 Willow Street Pike N Ste 310
Willow Street, PA 17584-9386
Phone (717) 947-4843

Other practice location 1

2168 Embassy Dr
Lancaster, PA 17603-2392
Phone (717) 299-7182

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20190528002534 PA Practitioner - Optometry 6608119060 Reassigns benefits to 3 organizations
Practice locations: East Petersburg, PA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG003207PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Pennsylvania, LLC Optometrist Current Accepting new patients
Myeyedr. Optometry of Pennsylvania, LLC Optometrist CurrentSince May 1, 2023 Accepting new patients
Myeyedr Optometry of Pennsylvania, LLC Optometrist CurrentSince May 1, 2023 Accepting new patients
Prime Opticals LLC PastSince Sep 29, 2021 Accepting new patients

Locations

125 S Antrim Way
Greencastle, PA 17225
Phone (717) 597-4780

14625 Mount Airy Rd
Ste 109
Shrewsbury, PA 17361
Phone (717) 227-2030

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Interoperability endpoints

  • Direct secure messaging: tyler.reppertod@direct.revolutionehr.com

Organizations & group practices 17

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.

View all 17

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Pennsylvania LLC 118 clinicians

Practice addresses (Care Compare)

125 S Antrim Way
Greencastle, PA 17225-1521
Phone (717) 597-4780

2791 S Queen St
Dallastown, PA 17313-9540
Phone (717) 741-4788

5503 Main St
East Petersburg, PA 17520-1500
Phone (717) 500-2962

NPI Registry JSON

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1215486121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 WILLOW STREET PIKE N STE 310",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849386",
            "telephone_number": "717-947-4843",
            "fax_number": "717-947-4279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 WILLOW STREET PIKE N STE 310",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849386",
            "telephone_number": "717-947-4843",
            "fax_number": "717-947-4279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2168 Embassy Dr",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176032392",
            "country_code": "US",
            "telephone_number": "717-299-7182",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REPPERT",
        "first_name": "TYLER",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-04",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willow Street, PA

Sources for this page

Verify at the official NPI Registry.