NPIMap

Organization Active NPI

Troy Humphreys OD Faao, Professional Corporation

Doing business as Legacy Optometry

  • Optometrist
  • Susanville, CA
National Provider Identifier
1326660960
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TROY HUMPHREYS OD FAAO, PROFESSIONAL CORPORATION
Doing business as
Legacy Optometry
Practice address
600 Ash St
Susanville, CA 96130-3714
Phone
(530) 257-4424
Fax
(530) 237-0426
NPI assigned
May 16, 2020
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Authorized official

Name
Dr. Troy Michael Humphreys, ODNPI 1992712194
Title
Owner/Doctor of Optometry
Phone
(530) 257-4424

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 NU Primary

Addresses

Primary practice location

600 Ash St
Susanville, CA 96130-3714

Mailing address

600 Ash St
Susanville, CA 96130-3714
Phone (530) 257-4424

Other identifiers 2

IdentifierTypeStateIssuer
002516454MedicaidNV
V33674OtherNVNORIDIAN

Other names 1

  • Legacy Optometry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200730000833 CA Part B Supplier - Clinic/Group Practice 9335564970 Receives reassigned benefits from 39 practitioners
Practice locations: Susanville, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 42

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.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1589587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1326660960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 ASH ST",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961303714",
            "telephone_number": "530-257-4424",
            "fax_number": "530-237-0426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ASH ST",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961303714",
            "telephone_number": "530-257-4424",
            "fax_number": "530-237-0426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TROY HUMPHREYS OD FAAO, PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-16",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "HUMPHREYS",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/DOCTOR OF OPTOMETRY",
        "authorized_official_telephone_number": "530-257-4424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002516454",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN",
            "identifier": "V33674",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Susanville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; 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.