Active NPI
Jacob G. Despain OD PC
Doing business as Family Vision Clinic
- Optometrist
- Lovell, WY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 327T
- Legal business name
- JACOB G. DESPAIN OD PC
- Doing business as
- Family Vision Clinic
- Practice address
- 426 Nevada Ave
Lovell, WY 82431-1916 - Phone
- (307) 548-7450
- Fax
- (307) 548-7596
- NPI assigned
- May 19, 2014
- Last updated
- May 19, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jacob G Despain, O.D.
- Title
- Optometrist
- Phone
- (307) 587-2404
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 327T | WY | Primary |
Addresses
Primary practice location
426 Nevada Ave
Lovell, WY 82431-1916
Mailing address
426 Nevada Ave
Lovell, WY 82431-1916
Phone (307) 548-7450
Other names 1
- Family Vision Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
Enrollment records 2
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
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
- Family Vision Clinic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Locations
426 Nevada Ave
Lovell, WY 82431
Phone (307) 548-7450
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Optometrist
- Cody, WY
- NPI 1124284997
-
- Optometrist
- Cody, WY
- NPI 1477544161
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400457600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1400457600000",
"number": "1326459835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "426 NEVADA AVE",
"city": "LOVELL",
"state": "WY",
"postal_code": "824311916",
"telephone_number": "307-548-7450",
"fax_number": "307-548-7596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "426 NEVADA AVE",
"city": "LOVELL",
"state": "WY",
"postal_code": "824311916",
"telephone_number": "307-548-7450",
"fax_number": "307-548-7596"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACOB G. DESPAIN OD PC",
"organizational_subpart": "NO",
"enumeration_date": "2014-05-19",
"last_updated": "2014-05-19",
"status": "A",
"authorized_official_last_name": "DESPAIN",
"authorized_official_first_name": "JACOB",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "307-587-2404",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WY",
"license": "327T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Family Vision Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lovell, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; 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.