NPIMap

Organization Active NPI

Ballantyne Vision Care LLC

  • Optometrist
  • La Junta, CO
National Provider Identifier
1306146121
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2799 Issued in 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
Last updated
Oct 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

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

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2799 CO Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Ark Valley Vision Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1288051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1306146121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810500305",
            "telephone_number": "719-383-0134",
            "fax_number": "719-404-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W 3RD ST",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810501430",
            "telephone_number": "719-383-0134",
            "fax_number": "719-404-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALLANTYNE VISION CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-26",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "BALLANTYNE",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "OPTOMETRIST, OWNER",
        "authorized_official_telephone_number": "719-383-0134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Junta, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare 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.