NPIMap

Organization Active NPI

Eye Specialist Inc

  • Ophthalmology Physician
  • Waverly, OH
National Provider Identifier
1457300683
Registry record updated Sep 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE SPECIALIST INC
Practice address
505 West Emmitt Avenue
Suite 4
Waverly, OH 45690-1084
Phone
(740) 941-3937
Fax
(740) 941-3786
NPI assigned
May 6, 2006
Last updated
Sep 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2014

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

Authorized official

Name
Terry Shultz, OD
Title
Center Director
Phone
(800) 948-3937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

505 West Emmitt Avenue
Suite 4
Waverly, OH 45690-1084

Mailing address

50 N Plaza Blvd
Chillicothe, OH 45601-1757
Phone (866) 587-8790

Other identifiers 1

IdentifierTypeStateIssuer
2368941MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040107000253 OH Part B Supplier - Clinic/Group Practice 5799684957 Receives reassigned benefits from 13 practitioners
7 other NPIs on this enrollment
Practice locations: Washington Court House, OH; Worthington, OH; Wilmington, OH; Waverly, OH; Portsmouth, OH; Lancaster, OH; Grove City, OH; Circleville, OH…

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Eye Specialist Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

307 E Emmitt Ave
Waverly, OH 45690
Phone (740) 941-3937

505 W Emmitt Ave
Ste 4
Waverly, OH 45690
Phone (740) 941-3937

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410739200000",
    "number": "1457300683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 N PLAZA BLVD",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456011757",
            "telephone_number": "866-587-8790",
            "fax_number": "740-774-4061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 WEST EMMITT AVENUE",
            "address_2": "SUITE 4",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456901084",
            "telephone_number": "740-941-3937",
            "fax_number": "740-941-3786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SPECIALIST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-06",
        "last_updated": "2014-09-15",
        "status": "A",
        "authorized_official_last_name": "SHULTZ",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CENTER DIRECTOR",
        "authorized_official_telephone_number": "800-948-3937",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2368941",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waverly, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.