Individual provider Active NPI

Jeffrey A Netzel, O.D.

  • Optometrist
  • Bentonville, AR
National Provider Identifier
1235145046
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2529 Issued in AR
Practice address
1720 S Walton Blvd
Ste 2
Bentonville, AR 72712-7172
Phone
(479) 271-2225
Fax
(479) 271-6225
NPI assigned
Aug 1, 2006
Last updated
May 29, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2529 AR Primary

Addresses

Primary practice location

1720 S Walton Blvd
Ste 2
Bentonville, AR 72712-7172

Mailing address

1720 S Walton Blvd
Ste 2
Bentonville, AR 72712-7172
Phone (479) 271-2225

Other identifiers 1

IdentifierTypeStateIssuer
149488722MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20100828000060 AR Practitioner - Optometry 8628192671 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1720 S Walton Blvd
Suite 2
Bentonville, AR 72712-7533
Phone (479) 271-2225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2529ARMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeff Netzel O.D. PA Optometrist CurrentSince Mar 31, 2003 Accepting new patients

Locations

1720 S Walton Blvd
Ste 2
Bentonville, AR 72712
Phone (479) 271-2225

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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212019200000",
    "number": "1235145046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 S WALTON BLVD",
            "address_2": "STE 2",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127172",
            "telephone_number": "479-271-2225",
            "fax_number": "479-271-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 S WALTON BLVD",
            "address_2": "STE 2",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127172",
            "telephone_number": "479-271-2225",
            "fax_number": "479-271-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETZEL",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149488722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.