Active NPI
Parkside Eyecare, PLLC
- Optometrist
- Edmond, OK
National Provider Identifier
1386281186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- PARKSIDE EYECARE, PLLC
- Practice address
- 318 S Littler Ave
Edmond, OK 73034-3823 - Phone
- (405) 341-3567
- Fax
- (405) 359-2000
- NPI assigned
- Nov 30, 2019
- 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
- Dr. Jennifer Julie Moore, OD
- Title
- Optometrist
- Phone
- (405) 824-3181
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 | Primary |
Addresses
Primary practice location
318 S Littler Ave
Edmond, OK 73034-3823
Mailing address
318 S Littler Ave
Edmond, OK 73034-3823
Phone (405) 341-3567
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200115110A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200921002114 | OK | Part B Supplier - Clinic/Group Practice | 5193141372 |
Receives reassigned benefits from 4 practitioners Practice locations: Edmond, OK |
National Provider Directory
National Provider DirectoryPractitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575072000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1599868800000",
"number": "1386281186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "318 S LITTLER AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730343823",
"telephone_number": "405-341-3567",
"fax_number": "405-359-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "318 S LITTLER AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730343823",
"telephone_number": "405-341-3567",
"fax_number": "405-359-2000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PARKSIDE EYECARE, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-11-30",
"last_updated": "2020-09-12",
"certification_date": "2020-09-04",
"status": "A",
"authorized_official_last_name": "MOORE",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "JULIE",
"authorized_official_title_or_position": "OPTOMETRIST",
"authorized_official_telephone_number": "405-824-3181",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200115110A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2020; 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.