Active NPI
Michael C Eller, O.D.
- Optometrist
- El Dorado, AR
National Provider Identifier
1396059002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2647
- Practice address
- 310 Thompson Ave
El Dorado, AR 71730-4569 - Phone
- (870) 862-4216
- Fax
- (870) 862-9011
- NPI assigned
- Aug 5, 2010
- Last updated
- Jan 26, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2647 | AR | Primary |
Addresses
Primary practice location
310 Thompson Ave
El Dorado, AR 71730-4569
Mailing address
310 Thompson Ave
El Dorado, AR 71730-4569
Phone (870) 862-4216
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 188676722 | Medicaid | AR | |
| P00986548 | Other | AR | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2647 | AR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327536000000",
"number": "1396059002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 THOMPSON AVE",
"city": "EL DORADO",
"state": "AR",
"postal_code": "717304569",
"telephone_number": "870-862-4216",
"fax_number": "870-862-9011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 THOMPSON AVE",
"city": "EL DORADO",
"state": "AR",
"postal_code": "717304569",
"telephone_number": "870-862-4216",
"fax_number": "870-862-9011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLER",
"first_name": "MICHAEL",
"middle_name": "C",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-05",
"last_updated": "2012-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AR",
"license": "2647",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "188676722",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00986548",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Dorado, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.