Organization Active NPI

Optometric Associates of Cedar Rapids,P.C.

  • Optometrist
  • Cedar Rapids, IA
National Provider Identifier
1396817367
Registry record updated Jan 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1460 Issued in IA
Legal business name
OPTOMETRIC ASSOCIATES OF CEDAR RAPIDS,P.C.
Practice address
860 2ND Ave SE
Ste. B
Cedar Rapids, IA 52403-2460
Phone
(319) 365-8621
Fax
(319) 365-9500
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2008

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

Authorized official

Name
Dr. Robert M Livin, O.D.
Title
President
Phone
(319) 365-8621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1460 IA Primary

Addresses

Primary practice location

860 2ND Ave SE
Ste. B
Cedar Rapids, IA 52403-2460

Mailing address

860 2ND Ave SE
Ste. B
Cedar Rapids, IA 52403-2460
Phone (319) 365-8621

Other identifiers 2

IdentifierTypeStateIssuer
07579OtherIABLUE CROSS,BLUE SHIELD
0075796MedicaidIA

National Provider Directory

National Provider Directory

Locations

860 2nd Ave SE
Ste B
Cedar Rapids, IA 52403
Phone (219) 365-8621

Practitioners & affiliated clinicians

Practitioners 1

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": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1396817367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 2ND AVE SE",
            "address_2": "STE. B",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524032460",
            "telephone_number": "319-365-8621",
            "fax_number": "319-365-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 2ND AVE SE",
            "address_2": "STE. B",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524032460",
            "telephone_number": "319-365-8621",
            "fax_number": "319-365-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC ASSOCIATES OF CEDAR RAPIDS,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "LIVIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "319-365-8621",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS,BLUE SHIELD",
            "identifier": "07579",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0075796",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.