Grand Teton Eye & Optical

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100010 Issued in ID

Legal business name

GRAND TETON EYE & OPTICAL

Practice address

110 Buffalo Way Ste a
Jackson, WY 83002-8460

Phone

(307) 733-4905

NPI assigned

Jan 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Chad Lewis Roberts, ODNPI 1295863504

Title

Owner

Phone

(208) 787-2088

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Practitioners 3

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

• Chad Roberts, O.D.

  • Optometrist
  • Jackson, WY
  • NPI 1295863504
  Medicare reassignment Authorized official
• Lisa Eileen Glenn, O.D.

  • Optometrist
  • Pinedale, WY
  • NPI 1487796330
  NPD (past)
• Thorman E Sholey, O.D.

  • Optometrist
  • Worland, WY
  • NPI 1376781872
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1306983655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 613",
            "city": "VICTOR",
            "state": "ID",
            "postal_code": "834550613",
            "telephone_number": "208-787-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BUFFALO WAY STE A",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830028460",
            "telephone_number": "307-733-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TETON EYE & OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-787-2088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andi Gordon, PT
• Oliver Goss, LCSW
• Grand Anesthesiology Services PC
• Grand Steps Therapy, PC
• Grand Teton Anesthesia, LLC
• Lisa Brady Grant, DC
• Jeffrey D Greenbaum, MD
• Cynthia Clark Griggs, OTR, CHT
• Jessica Grim, PT, DPT
• Gros Ventre OB/GYN, LLP

• Optometrist in Jackson, WY
• Providers in Jackson, WY by specialty
• Optometrist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.