Active NPI
Optometric Associates of Cedar Rapids,P.C.
- Optometrist
- Cedar Rapids, IA
National Provider Identifier
1396817367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1460
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07579 | Other | IA | BLUE CROSS,BLUE SHIELD |
| 0075796 | Medicaid | IA |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Optometrist
- Cedar Rapids, IA
- NPI 1982649349
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.