NPIMap

Organization Active NPI

DRS. Roush & Will Optometrists, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Kendallville, IN
National Provider Identifier
1275656209
Registry record updated Jul 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
56000032A Issued in IN
Legal business name
DRS. ROUSH & WILL OPTOMETRISTS, INC.
Practice address
781 E. North St.
Kendallville, IN 46755-1225
Phone
(260) 347-3458
Fax
(260) 347-4425
NPI assigned
Apr 6, 2007
Last updated
Jul 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2016

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

Authorized official

Name
Dr. R Alan Roush, O.D.
Title
President
Phone
(260) 347-3611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 56000032A IN Primary

Addresses

Primary practice location

781 E. North St.
Kendallville, IN 46755-1225

Mailing address

781 E. North St
Kendallville, IN 46755-1225
Phone (260) 347-3458

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930078232 IN DME Supplier - Physician - Optometrist 9830165026 Practice locations: Kendallville, IN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
DRS Roush & Will Optometrists Inc781 E North St, Kendallville, IN 46755-1225(260) 347-3458 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1995

National Provider Directory

National Provider Directory
Tax ID family
DRS Roush Will Optometrists2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469664000000",
    "number": "1275656209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 E. NORTH ST",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467551225",
            "telephone_number": "260-347-3458",
            "fax_number": "260-347-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 E. NORTH ST.",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467551225",
            "telephone_number": "260-347-3458",
            "fax_number": "260-347-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. ROUSH & WILL OPTOMETRISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2016-07-28",
        "status": "A",
        "authorized_official_last_name": "ROUSH",
        "authorized_official_first_name": "R ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-347-3611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "56000032A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kendallville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.