Ict Eye LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

04-29078 Issued in KS

Legal business name

ICT EYE LLC

Practice address

9300 E 29TH St N Ste 315
Wichita, KS 67226-2184

Phone

(316) 425-0445

Fax

(316) 425-0460

NPI assigned

Jan 5, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer K Burgoyne, M.D.NPI 1912943408

Title

Owner

Phone

(316) 841-2805

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer K Burgoyne, M.D.

  • Ophthalmology Physician
  • Wichita, KS
  • NPI 1912943408
  Medicare reassignment NPD Authorized official
• Jamie L Speth, OD

  • Optometrist
  • Wichita, KS
  • NPI 1659429116
  Medicare reassignment NPD

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1427446178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672010743",
            "telephone_number": "316-425-0445",
            "fax_number": "316-425-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 E 29TH ST N STE 315",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672262184",
            "telephone_number": "316-425-0445",
            "fax_number": "316-425-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICT EYE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "BURGOYNE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-841-2805",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "KS",
            "license": "04-29078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Ophthalmology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.