Iola Vision Source, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

IOLA VISION SOURCE, LLC

Practice address

216 N Jefferson Ave
Iola, KS 66749-2943

Phone

(620) 365-2108

Fax

(620) 365-2108

NPI assigned

Oct 11, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Douglas A Donnelly, ODNPI 1912972308

Title

Member

Phone

(620) 365-2108

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

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.

• Douglas Alan Donnelly, O.D.

  • Optometrist
  • Iola, KS
  • NPI 1912972308
  Medicare reassignment Care Compare group NPD Authorized official
• Matthew Dennis Skahan, O.D.

  • Optometrist
  • Iola, KS
  • NPI 1528033677
  Medicare reassignment Care Compare group
• Michael George Reynolds, M.D.

  • Specialist
  • Emporia, KS
  • NPI 1760486526
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1568550754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847",
            "city": "IOLA",
            "state": "KS",
            "postal_code": "667490847",
            "telephone_number": "620-365-2108",
            "fax_number": "620-365-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N JEFFERSON AVE",
            "city": "IOLA",
            "state": "KS",
            "postal_code": "667492943",
            "telephone_number": "620-365-2108",
            "fax_number": "620-365-2108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 N Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Iola",
            "state": "KS",
            "postal_code": "667492353",
            "country_code": "US",
            "telephone_number": "620-365-2108",
            "fax_number": "620-365-2522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IOLA VISION SOURCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "620-365-2108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE #",
            "identifier": "DA4480",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100642380A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Iola Pharmacy Inc (Iola Pharmacy Clinic)
• Iola Pharmacy Inc (Gericare LTC)
• Iola Pharmacy Inc (Iola Pharmacy)
• Iola Pharmacy Inc. (Iola Pharmacy Respiratory & Medical)
• Iola Rehabilitation & Health Care Center LLC (Iola Nursing & Residential Care Center)
• Autumn Irwin, LAC
• Kelsey Jane Johnson
• Shannon Nicole Johnson, APRN
• William Ryan Jones
• David Willis Jordan, CRNA

• Optometrist in Iola, KS
• Providers in Iola, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.