Canaan Matthew Montgomery, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1958DT Issued in KY

Practice address

2559 New Holt Rd
Paducah, KY 42001-7503

Phone

(270) 558-4741

Fax

(270) 558-4742

NPI assigned

Jun 18, 2014

Last updated

Sep 19, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Optometry

Education

Southern College of Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West End Eye Care LTDGroup PAC ID 2961622386, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• West End Eye Care, LTD.

  • Optometrist
  • Paducah, KY
  • NPI 1578972113
  Medicare reassignment Care Compare group NPD Authorized official
• Four Rivers Vision Therapy, PLLC

  • Optometrist
  • Paducah, KY
  • NPI 1508255464
  Authorized official Same address or phone

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1225442288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2559 NEW HOLT RD",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017503",
            "telephone_number": "270-558-4741",
            "fax_number": "270-558-4742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2559 NEW HOLT RD",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017503",
            "telephone_number": "270-558-4741",
            "fax_number": "270-558-4742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "CANAAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-18",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1958DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariana Valentina Mirasolo
• Isaac Mittendorf, MD
• Katherine Moffatt
• Kennedie Mohney
• Madelyn Nicole Monroe, MS CF-SLP
• Nicholas Scott Moon
• Erin Elizabeth Mooney
• David Ryan Moore, RN
• William Ryan Moore, PHARMD, RPH
• Linda Mae Moran, CERT SURG 1ST ASST

• Optometrist in Paducah, KY
• Providers in Paducah, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.