Ballantyne Vision Care LLC – Optometrist

Key facts

NPI: 1306146121
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
License: 2799 (CO)
Legal business name: BALLANTYNE VISION CARE LLC
Practice address: 302 W 3Rd St
La Junta, CO 81050-1430
Phone: (719) 383-0134
Fax: (719) 404-1825
NPI assigned: Oct 26, 2010
Organization subpart: No

Authorized official

Name: Dr. Jordan Ballantyne, O.D. NPI 1326352212
Title: Optometrist, Owner
Phone: (719) 383-0134

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Ballantyne Vision Care LLC Optometrist · Lamar, CO · NPI 1154994549

Same enrollment O20110616000494

Corporate family (same tax ID) 1

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

Ballantyne Vision Care LLC Optometrist · Lamar, CO · NPI 1154994549

NPD tax ID

Practitioners 3

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

Jordan Brett Ballantyne, O.D. Optometrist · La Junta, CO · NPI 1326352212

Medicare reassignment Care Compare group NPD Authorized official CO · OPTOMETRIST
Charles Nolan Philpy, OD Optometrist · Lamar, CO · NPI 1700316593

Medicare reassignment Care Compare group NPD CO · OPTOMETRIST
Taylor Lane Sutton, OD Optometrist · Lamar, CO · NPI 1518784933

Medicare reassignment NPD CO · OPTOMETRIST

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CO

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20110616000494	CO	Part B Supplier - Clinic/Group Practice	5991983199	Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment Practice locations: La Junta, CO; Lamar, CO

National Provider Directory

Tax ID family: Ark Valley Vision Care (2 organizations share this tax ID)

Locations

302 W 3rd St
La Junta, CO 81050
Phone (719) 383-0134

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193400000X SINGLE SPECIALTY GROUP	152W00000X	2799	CO	Yes

Addresses

Primary practice location

302 W 3Rd St
La Junta, CO 81050-1430

Mailing address

PO Box 305
La Junta, CO 81050-0305
Phone (719) 383-0134

Other identifiers

Identifier	Type	State	Issuer
COA106109	Other	CO	MEDICARE GROUP PTAN
93920288	Medicaid	CO
1306146121	Other	CO	NPI FOR LAMAR OFFICE

Other providers in La Junta, CO

Arkansas Valley Regional Medical Center Nursing Care Center
Arkansas Valley Regional Medical Center Respite Care
Arkansas Valley Regional Medical Center Swing Bed
Jessica Ashenfelter, PHARMD
Carmalita Baca
Jordan Brett Ballantyne, O.D.
Roy Alan Barnett
Veronica Ethel Bartlett, FNP, MS-RN
Jared Bateman
Theresa Marie Bauer, LPC, CAC III

All providers in La Junta, CO · Optometrist in Colorado

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2016. 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.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.