NPIMap

DRS. Roush & Will Optometrists, Inc.

Organization Active NPI Durable Medical Equipment & Medical Supplies · Kendallville, IN

NPI 1275656209 · NPPES record last updated Jul 28, 2016

Key facts

NPI
1275656209
Entity type
Organization (NPI type 2)
Primary specialty
Durable Medical Equipment & Medical Supplies 332B00000X
License
56000032A (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
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 1

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

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
DRS Roush & Will Optometrists Inc
781 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 assignment
Participating since Jan 1, 1995

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IN

Medicare enrollment records

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

National Provider Directory

Tax ID family
DRS Roush Will Optometrists (2 organizations share this tax ID)

Specialties & licenses

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

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

Other identifiers

IdentifierTypeStateIssuer
100355140BMedicaidIN
100355140AMedicaidIN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 28, 2016.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100355140B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100355140A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kendallville, IN

All providers in Kendallville, IN · Durable Medical Equipment & Medical Supplies in Indiana

Sources for this page

Verify at the official NPI Registry.