Stacey a Pruitt OD,Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

STACEY A PRUITT OD,INC

Practice address

1250 N State St
Greenfield, IN 46140-1055

Phone

(812) 614-1411

NPI assigned

Feb 20, 2019

Organization subpart

No

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

Authorized official

Name

Stacey A Pruitt, ODNPI 1700837069

Title

Optometrist

Phone

(812) 614-1411

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

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

• Stacey A Pruitt, OD

  • Optometrist
  • Greenfield, IN
  • NPI 1700837069
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550620800000",
    "number": "1508322009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10639 WINDJAMMER CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462368934",
            "telephone_number": "812-614-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 N STATE ST",
            "city": "GREENFIELD",
            "state": "IN",
            "postal_code": "461401055",
            "telephone_number": "812-614-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY A PRUITT OD,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-20",
        "last_updated": "2019-02-20",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "812-614-1411",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300022485",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Solomon
• Erica Charlene Speck
• Cindy Spier, MD
• Kimberly Spiller
• St Vincent Heart Care
• Merissa Standridge, DPT
• Kathryn Ann Starost, PTA
• Matthew Carl Statzer
• Natalie Stclair, FNP-C
• Andrise Steele

• Optometrist in Greenfield, IN
• Providers in Greenfield, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2019; 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.