Ethan Ranger Taylor, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT949 Issued in ME

Practice address

824 Stillwater Avenue
Bangor, ME 04401-3614

Phone

(207) 847-7554

NPI assigned

Sep 20, 2013

Last updated

Aug 20, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

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

Specialty

Optometry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Smart Vision LLCGroup PAC ID 8022393230, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Smart Vision, LLC

  • Optometrist
  • Augusta, ME
  • NPI 1043394885
  Medicare reassignment Care Compare group
• Smart Vision, LLC

  • Optometrist
  • Farmingdale, ME
  • NPI 1245309400
  NPD
• Smart Vision, LLC

  • Optometrist
  • Bangor, ME
  • NPI 1811066079
  NPD (past)

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

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440028800000",
    "number": "1306272406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 STILLWATER AVENUE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013614",
            "telephone_number": "207-847-7554",
            "fax_number": "207-945-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 STILLWATER AVENUE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013614",
            "telephone_number": "207-847-7554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "ETHAN",
        "middle_name": "RANGER",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-20",
        "last_updated": "2015-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT949",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3398",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Marie Taylor, LCPC
• Ashley Nichole Taylor, LCSW
• Corey Michael Taylor
• Courtney Lee Taylor, AGACNP
• Eric C Taylor, LCSW
• Jennifer Wynne Taylor, PMHNP-BC
• Leeanne Taylor, MS, LADC
• Maria Elizabeth Taylor, LMSW-CC
• Mary E Taylor, PA-C
• Mary Tedesco-Schneck, PNPC

• Optometrist in Bangor, ME
• Providers in Bangor, ME by specialty
• Optometrist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.