NPIMap

Organization Active NPI

Northside Eyecare Associates, LLC

  • Optometrist
  • Evansville, IN
National Provider Identifier
1306077839
Registry record updated Jan 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18003164 Issued in IN
Legal business name
NORTHSIDE EYECARE ASSOCIATES, LLC
Practice address
634 Cross Valley Cir
Evansville, IN 47710-5238
Phone
(812) 401-7777
Fax
(812) 429-0392
NPI assigned
Jul 31, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2013

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

Authorized official

Name
Dr. Jeffrey D. Irvin, O.D.NPI 1013025683
Title
Owner
Phone
(812) 401-7777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 18003164 IN Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 18003181 IN

Addresses

Primary practice location

634 Cross Valley Cir
Evansville, IN 47710-5238

Mailing address

634 Cross Valley Cir
Evansville, IN 47710-5238
Phone (812) 401-7777

Other identifiers 3

IdentifierTypeStateIssuer
200981140MedicaidIN
DR3932OtherINRAILROAD MEDICARE
6503910001OtherINDMERC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100324000165 IN Part B Supplier - Clinic/Group Practice 3678615259 Receives reassigned benefits from 5 practitioners
Practice locations: Evansville, IN
O20110427000151 IN DME Supplier - Physician - Optometrist 3678615259 Practice locations: Evansville, IN

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
Northside Eyecare Associates, LLC634 Cross Valley Cir, Evansville, IN 47710-5238(812) 401-7777 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Apr 22, 2010

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1248998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358726400000",
    "number": "1306077839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "634 CROSS VALLEY CIR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477105238",
            "telephone_number": "812-401-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 CROSS VALLEY CIR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477105238",
            "telephone_number": "812-401-7777",
            "fax_number": "812-429-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE EYECARE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-31",
        "last_updated": "2013-01-21",
        "status": "A",
        "authorized_official_last_name": "IRVIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-401-7777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003164",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003181",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200981140",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DR3932",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "6503910001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2013; 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.