Polly A Nelson, O.D.
Individual provider Active NPI Optometrist · Savannah, MO
NPI 1295766657 · NPPES record last updated Jun 28, 2010
Key facts
- NPI
- 1295766657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TO2956 (MO)
- Practice address
- 502 South US 71 Hwy
Ste 1
Savannah, MO 64485-2041 - Phone
- (816) 324-2020
- Fax
- (816) 324-6407
- NPI assigned
- Jul 5, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
502 S US Hwy 71
Suite 1
Savannah, MO 64485-2503
Phone (816) 324-2020
502 S US Hwy 71 1
Savannah, MO 64485-2503
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101217000685 | MO | Practitioner - Optometry | 0648468603 | Practice locations: Savannah, MO; Stanberry, MO |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TO2956 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spec Shoppe II | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TO2956 | MO | Yes |
Addresses
Primary practice location
502 South US 71 Hwy
Ste 1
Savannah, MO 64485-2041
Mailing address
502 South US 71 Hwy
Ste 1
Savannah, MO 64485-2041
Phone (816) 324-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22793-015 | Other | MO | BLUE CROSS BLUE SHIELD OF |
| 312965007 | Medicaid | MO |
Other providers in Savannah, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.