Individual provider Active NPI

Clarissa Kum

  • Optometrist
  • Memphis, TN
National Provider Identifier
1558777078
Registry record updated Feb 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
56008208 Issued in NY
Practice address
1030 Jefferson Ave
Memphis, TN 38104-2127
Phone
(901) 523-8990
NPI assigned
Jul 3, 2014
Last updated
Feb 7, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 56008208 NY Primary

Addresses

Primary practice location

1030 Jefferson Ave
Memphis, TN 38104-2127

Mailing address

1030 Jefferson Ave
Cw104A
Memphis, TN 38104-2127

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170810002433 TX Practitioner - Optometry 1951618131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

500 Indiana Ave
Winslow, AZ 86047-2169

500 N Indiana Ave
Winslow, AZ 86047-2169
Phone (928) 289-4646

SWC Navajo Route 15 and 60
1 Medical Center Dr
Dilkon, AZ 86047-2169
Phone (928) 289-4646

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
56008208NYMDOptometrist
2179AZMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Winslow Indian Health Care Center, Inc CurrentSince Jul 17, 2017 Accepting new patients
Dilkon Medical Center Current Accepting new patients
Winslow Indian Health Care Center, Inc CurrentSince Jul 17, 2017 Accepting new patients

Locations

500 Indiana Ave
Winslow, AZ 86047

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1404345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423267200000",
    "number": "1558777078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 JEFFERSON AVE",
            "address_2": "CW104A",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042127",
            "telephone_number": "901-523-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUM",
        "first_name": "CLARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-03",
        "last_updated": "2015-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "56008208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.