Invista Optical, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003798 Issued in IN

Legal business name

INVISTA OPTICAL, LLC

Practice address

640 E Michigan St Ste B
Indianapolis, IN 46202-0007

Phone

(317) 929-1401

Fax

(317) 929-1399

NPI assigned

Oct 16, 2015

Organization subpart

No

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

Authorized official

Name

Samantha Jahnke, ODNPI 1841639325

Title

Owner/Optometrist

Phone

(765) 346-0852

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 2

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

• Samantha Nichole Jahnke, OD

  • Optometrist
  • Bloomington, IN
  • NPI 1841639325
  Medicare reassignment NPD Authorized official
• Erin Leyden, OD

  • Optometrist
  • Indianapolis, IN
  • NPI 1093632903
  NPD (past)

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

{
    "created_epoch": "1444953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1376914234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 ROYAL OAK DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462277075",
            "telephone_number": "765-346-0852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 E MICHIGAN ST STE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462020007",
            "telephone_number": "317-929-1401",
            "fax_number": "317-929-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INVISTA OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-16",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "JAHNKE",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "765-346-0852",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201205510",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.