Individual provider Active NPI

Bob Joe, O.D.

  • Optometrist
  • Austin, TX
National Provider Identifier
1245276443
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2286TG Issued in TX
Practice address
8105 Shoal Creek Blvd
Suite a
Austin, TX 78757-8040
Phone
(512) 454-4641
Fax
(512) 454-1065
NPI assigned
Jun 22, 2006
Last updated
Mar 4, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2286TG TX Primary
Corneal and Contact Management Optometrist 152WC0802X 2286TG TX
Pediatric Optometrist 152WP0200X 2286TG TX

Addresses

Primary practice location

8105 Shoal Creek Blvd
Suite a
Austin, TX 78757-8040

Mailing address

8105 Shoal Creek Blvd
Suite a
Austin, TX 78757-8040
Phone (512) 454-4641

Other identifiers 1

IdentifierTypeStateIssuer
81662QOtherTXBCBS UPIN

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
I20070521000171 TX Practitioner - Optometry 6305943739 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2286TGTXMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Awod, PLLC Optometrist CurrentSince Mar 16, 2011 Accepting new patients

Locations

8105 Shoal Creek Blvd
#A
Austin, TX 78757
Phone (512) 454-4641

Interoperability endpoints

  • Direct secure messaging: direct@austinoptometrygrouplpaustintx.compulinkdirect.com

Organizations & group practices 2

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204588800000",
    "number": "1245276443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8105 SHOAL CREEK BLVD",
            "address_2": "SUITE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787578040",
            "telephone_number": "512-454-4641",
            "fax_number": "512-454-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8105 SHOAL CREEK BLVD",
            "address_2": "SUITE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787578040",
            "telephone_number": "512-454-4641",
            "fax_number": "512-454-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOE",
        "first_name": "BOB",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2008-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2286TG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "2286TG",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "TX",
            "license": "2286TG",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS UPIN",
            "identifier": "81662Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.