Individual provider Active NPI

Amanda J Mataya Pietig, O.D.

  • Optometrist
  • Ankeny, IA
National Provider Identifier
1295926228
Registry record updated Feb 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
002401 Issued in IA
Practice address
311 N Ankeny Blvd
Ankeny, IA 50023-1711
Phone
(515) 964-1671
Fax
(515) 964-1714
NPI assigned
Aug 6, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 002401 IA Primary

Addresses

Primary practice location

311 N Ankeny Blvd
Ankeny, IA 50023-1711

Mailing address

311 N Ankeny Blvd
Ankeny, IA 50023-1711
Phone (515) 964-1671

Other identifiers 2

IdentifierTypeStateIssuer
71726OtherIABLUE CROSS
48179001OtherIAMEDICARE ID-TYPE UNSPECIF

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20080603000824 IA Practitioner - Optometry 7911077854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pietig Family Eyecare PLLCGroup PAC ID 4688955065, 5 clinicians

Practice addresses (Care Compare)

311 N Ankeny Blvd
Ankeny, IA 50023-1711
Phone (515) 964-1671

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002401IAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pietig Family Eyecare PLLC Optometrist CurrentSince Jan 2, 2017 Accepting new patients
Vision Park Family Eye Care Optometrist Past Accepting new patients
Vision Park Family Eye Care, LLP PastSince Jan 1, 2000 Accepting new patients
Robb Schmidt, OD, PC Optometrist PastSince Aug 4, 2003 Accepting new patients

Locations

311 N Ankeny Blvd
Ankeny, IA 50023
Phone (515) 222-6400

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360627200000",
    "number": "1295926228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 N ANKENY BLVD",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500231711",
            "telephone_number": "515-964-1671",
            "fax_number": "515-964-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N ANKENY BLVD",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500231711",
            "telephone_number": "515-964-1671",
            "fax_number": "515-964-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATAYA PIETIG",
        "first_name": "AMANDA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2013-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "002401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "71726",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIF",
            "identifier": "48179001",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.