Amanda Montgomery, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

6058 Issued in OH

Practice address

812 Coshocton Ave # 3
Mount Vernon, OH 43050-1947

Phone

(740) 326-1190

Fax

(740) 326-9753

NPI assigned

Aug 16, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Montgomery Eye Care, LLC

  dba Amazing Eyes Family Vision

  • Optometrist
  • Mount Vernon, OH
  • NPI 1407120140
  Medicare reassignment NPD Authorized official
• Knox Community Hospital

  dba KCH Northside Pharmacy

  • Community/Retail Pharmacy
  • Mount Vernon, OH
  • NPI 1073351557
  NPD (past)

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

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1417236803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 COSHOCTON AVE # 3",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430501947",
            "telephone_number": "740-326-1190",
            "fax_number": "740-326-9753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 COSHOCTON AVE # 3",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430501947",
            "telephone_number": "740-326-1190",
            "fax_number": "740-326-9753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "AMANDA",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-16",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "6058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112154",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPERIOR VISION",
            "identifier": "1417236803",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "CS1627100107",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monroe Township Knox County Oh (Monroe Township Fire Department)
• Mirna Monroy-Cubie, COTA/L
• John P Montenery, R.PH.
• Mary Lou Montenery, R.PH.
• Montgomery Eye Care, LLC (Amazing Eyes Family Vision)
• Laurie A Mooney, MD
• Anthony Moore, CDCA
• Bobbi Moore
• Heather Lynn Moore, RPH
• Jordan Russell Moore

• Optometrist in Mount Vernon, OH
• Providers in Mount Vernon, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.