Individual provider Active NPI

Justin Chelette, OD

  • Optometrist
  • Pikeville, KY
National Provider Identifier
1235668138
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2167DT Issued in KY
Practice address
147 Sycamore St
Pikeville, KY 41501-9118
Phone
(606) 218-5540
Fax
(606) 218-4451
NPI assigned
Jun 6, 2017
Last updated
Apr 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9306T TX
Optometrist 152W00000X 2167DT KY Primary

Addresses

Primary practice location

147 Sycamore St
Pikeville, KY 41501-9118

Mailing address

147 Sycamore St
Pikeville, KY 41501-9118
Phone (606) 218-5540

Other practice location 1

911 Bypass Rd Bldg A
Pikeville, KY 41501-1689
Phone (606) 430-2209

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address justin.chelette.p1@direct.pmc.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220901002498 TX Practitioner - Optometry 0547699167 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9306TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Houston CurrentSince Aug 26, 2022 Accepting new patients
University of Houston System Optometrist Current Accepting new patients
University of Houston System CurrentSince Aug 26, 2022 Accepting new patients
Texas Vision Therapy Current Accepting new patients
The Optometry Center for Vision Therapy Corp Optometrist Past Accepting new patients

Locations

190 Heights Blvd
Houston, TX 77007
Phone (713) 527-8480

4401 Martin Luther King Blvd
Houston, TX 77204
Phone (713) 743-1921

Organizations & group practices 5

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": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1235668138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 SYCAMORE ST",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415019118",
            "telephone_number": "606-218-5540",
            "fax_number": "606-218-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 SYCAMORE ST",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415019118",
            "telephone_number": "606-218-5540",
            "fax_number": "606-218-4451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Bypass Rd Bldg A",
            "address_purpose": "LOCATION",
            "city": "Pikeville",
            "state": "KY",
            "postal_code": "415011689",
            "country_code": "US",
            "telephone_number": "606-430-2209",
            "fax_number": "606-218-7509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHELETTE",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9306T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2167DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "justin.chelette.p1@direct.pmc.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "direct address for ccda",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "standard direct functionality",
            "address_1": "911 Bypass Rd Bldg A",
            "city": "Pikeville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "415011689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pikeville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.