Edward Stanley Jarka, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

T02796 Issued in MO

Practice address

7954 Big Bend Blvd
Webster Groves, MO 63119-2717

Phone

(314) 962-7580

Fax

(314) 962-7580

NPI assigned

Aug 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Mark D Peckham OD PC

  • Optometrist
  • Festus, MO
  • NPI 1346419645
  NPD (past)

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1477660769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7954 BIG BEND BLVD",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631192717",
            "telephone_number": "314-962-7580",
            "fax_number": "314-962-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7954 BIG BEND BLVD",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631192717",
            "telephone_number": "314-962-7580",
            "fax_number": "314-962-7580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 E Woodlawn Dr",
            "address_purpose": "LOCATION",
            "city": "Leadington",
            "state": "MO",
            "postal_code": "636014436",
            "country_code": "US",
            "telephone_number": "573-431-1301",
            "fax_number": "573-431-9339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Westwood Dr S",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "630282061",
            "country_code": "US",
            "telephone_number": "636-931-2020",
            "fax_number": "636-931-1883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JARKA",
        "first_name": "EDWARD",
        "middle_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477660769",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Webster Groves, MO
• Providers in Webster Groves, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.