NPIMap

Organization Active NPI

Archibald R Morris OD

  • Optometrist
  • Ebensburg, PA
National Provider Identifier
1316012107
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000628 Issued in PA
Legal business name
ARCHIBALD R MORRIS OD
Practice address
125 Manor Dr
Ebensburg, PA 15931-2081
Phone
(814) 472-9670
Fax
(814) 472-9704
NPI assigned
Nov 21, 2006
Last updated
Aug 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

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

Authorized official

Name
Archibald Regis Morris, ODNPI 1316011158
Title
Owner
Phone
(814) 472-9670

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
Optometrist 152W00000X OEG000628 PA Primary

Addresses

Primary practice location

125 Manor Dr
Ebensburg, PA 15931-2081

Mailing address

125 Manor Dr
Ebensburg, PA 15931-2081
Phone (814) 472-9670

Other identifiers 10

IdentifierTypeStateIssuer
DG2847OtherPAPALMETTO GBA RAILROADERS
PA06285OtherPAVBA
506722OtherPAHIGHMARK
50704OtherPADAVIS VISION
1361126OtherPAFUNDS
5153452OtherPAAETNA
0009711820002MedicaidPA
208734OtherPAUPMC
391971OtherPANVA
AM15624OtherPASPECTERA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050413000282 PA Part B Supplier - Clinic/Group Practice 5193762953 Receives reassigned benefits from 3 practitioners
Practice locations: Ebensburg, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
Archibald R Morris OD125 Manor Dr, Ebensburg, PA 15931-2081(814) 472-9670 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since May 27, 1987

National Provider Directory

National Provider Directory

Locations

125 Manor Dr
Ebensburg, PA 15931
Phone (814) 472-9670

Practitioners & affiliated clinicians

Practitioners 7

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": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314662400000",
    "number": "1316012107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 MANOR DR",
            "city": "EBENSBURG",
            "state": "PA",
            "postal_code": "159312081",
            "telephone_number": "814-472-9670",
            "fax_number": "814-472-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MANOR DR",
            "city": "EBENSBURG",
            "state": "PA",
            "postal_code": "159312081",
            "telephone_number": "814-472-9670",
            "fax_number": "814-472-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCHIBALD R MORRIS OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2011-08-30",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "ARCHIBALD",
        "authorized_official_middle_name": "REGIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-472-9670",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROADERS",
            "identifier": "DG2847",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VBA",
            "identifier": "PA06285",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "506722",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "50704",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FUNDS",
            "identifier": "1361126",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5153452",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009711820002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC",
            "identifier": "208734",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "391971",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "AM15624",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ebensburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; 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.