NPIMap

Organization Active NPI

Mark Bettencourt, O.D. PC

Doing business as Vision Source

  • Optometrist
  • Wamego, KS
National Provider Identifier
1295729846
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1234-2 Issued in KS
Legal business name
MARK BETTENCOURT, O.D. PC
Doing business as
Vision Source
Practice address
1405 W US Highway 24
Wamego, KS 66547-1256
Phone
(785) 456-8900
Fax
(785) 456-8902
NPI assigned
Sep 8, 2005
Last updated
Dec 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Authorized official

Name
Linda J Warren
Title
Office Manager
Phone
(785) 456-8900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1234-2 KS Primary

Addresses

Primary practice location

1405 W US Highway 24
Wamego, KS 66547-1256

Mailing address

1405 W US Highway 24
Wamego, KS 66547-1256
Phone (785) 456-8900

Other identifiers 3

IdentifierTypeStateIssuer
0692920001OtherKSDMERC
650563OtherKSBCBS
410014173OtherKSRAILROAD MEDICARE

Other names 1

  • Vision Source Doing business as

National Provider Directory

National Provider Directory

Locations

1405 W US Highway 24
Wamego, KS 66547
Phone (785) 456-8900

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1295729846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 W US HIGHWAY 24",
            "city": "WAMEGO",
            "state": "KS",
            "postal_code": "665471256",
            "telephone_number": "785-456-8900",
            "fax_number": "785-456-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 W US HIGHWAY 24",
            "city": "WAMEGO",
            "state": "KS",
            "postal_code": "665471256",
            "telephone_number": "785-456-8900",
            "fax_number": "785-456-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK BETTENCOURT, O.D. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "785-456-8900"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1234-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0692920001",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "650563",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410014173",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wamego, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.