NPIMap

Organization Active NPI

Jacksonville Vision Development Center PA

  • Optometrist
  • Jacksonville, AR
National Provider Identifier
1336782846
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JACKSONVILLE VISION DEVELOPMENT CENTER PA
Practice address
291 N 1St St
Jacksonville, AR 72076-4462
Phone
(501) 982-1100
Fax
(501) 982-0323
NPI assigned
Oct 28, 2019
Last updated
Dec 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Authorized official

Name
Dr. Patricia Flippin Westfall, ODNPI 1093709081
Title
Owner/President
Phone
(501) 268-3577

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 Primary

Addresses

Primary practice location

291 N 1St St
Jacksonville, AR 72076-4462

Mailing address

410 W Race Ave
Searcy, AR 72143-4133
Phone (501) 268-3577

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191231000044 AR Part B Supplier - Clinic/Group Practice 3173957024 Receives reassigned benefits from 2 practitioners
Practice locations: Jacksonville, AR

National Provider Directory

National Provider Directory

Locations

401 W Race Ave
AR 72143

291 N 1st St
Jacksonville, AR 72076
Phone (501) 268-3577

410 W Race Ave
Searcy, AR 72143
Phone (501) 268-3577

Practitioners & affiliated clinicians

Practitioners 9

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": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1336782846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 W RACE AVE",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721434133",
            "telephone_number": "501-268-3577",
            "fax_number": "501-268-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 N 1ST ST",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720764462",
            "telephone_number": "501-982-1100",
            "fax_number": "501-982-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE VISION DEVELOPMENT CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-28",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "WESTFALL",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "FLIPPIN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "501-268-3577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; 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.