NPIMap

Organization Active NPI

Four Rivers Vision Therapy, PLLC

  • Optometrist
  • Paducah, KY
National Provider Identifier
1508255464
Registry record updated Jan 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1958DT Issued in KY
Legal business name
FOUR RIVERS VISION THERAPY, PLLC
Practice address
4570 Pecan Dr
Suite C
Paducah, KY 42001-6717
Phone
(270) 558-4741
Fax
(270) 558-4742
NPI assigned
Jan 15, 2015
Last updated
Jan 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

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

Authorized official

Name
Dr. Canaan Matthew Montgomery, ODNPI 1225442288
Title
Owner
Phone
(270) 558-4741

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1958DT KY Primary

Addresses

Primary practice location

4570 Pecan Dr
Suite C
Paducah, KY 42001-6717

Mailing address

4570 Pecan Dr
Suite C
Paducah, KY 42001-6717
Phone (270) 558-4741

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1508255464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 PECAN DR",
            "address_2": "SUITE C",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420016717",
            "telephone_number": "270-558-4741",
            "fax_number": "270-558-4742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 PECAN DR",
            "address_2": "SUITE C",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420016717",
            "telephone_number": "270-558-4741",
            "fax_number": "270-558-4742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR RIVERS VISION THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "CANAAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-558-4741",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1958DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; 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.