Timothy R Landis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1O73-OD Issued in WV

Practice address

559 Vincent St BLDG 959
Peterson Afb, CO 80914-1541

Phone

(702) 653-3010

Fax

(702) 653-3023

NPI assigned

Aug 16, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Myeyedr Optometry of West Virginia, PLLC

  • Optometrist
  • Martinsburg, WV
  • NPI 1053760363
  Medicare reassignment NPD
• Myeyedr Optometry of West Virginia, PLLC

  • Optometrist
  • Parkersburg, WV
  • NPI 1356812804
  NPD
• Myeyedr Optometry of West Virginia, PLLC

  • Optometrist
  • Martinsburg, WV
  • NPI 1700235017
  NPD

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1578555645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1895 NATURE PARK DR",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890843151",
            "telephone_number": "270-319-8784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST BLDG 959",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "702-653-3010",
            "fax_number": "702-653-3023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "838 Somerset Blvd",
            "address_purpose": "LOCATION",
            "city": "Charles Town",
            "state": "WV",
            "postal_code": "254145625",
            "country_code": "US",
            "telephone_number": "304-725-4828",
            "fax_number": "304-725-4829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDIS",
        "first_name": "TIMOTHY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1322 DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "1O73-OD",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystin Hust, DPT
• Monica Ibarra, LCSW
• Krystelle Jean-Michel, PHD
• Catherine Marie Kerrigan, LCSW
• Candice Andrea Lagasse, PHARMD
• Amanda Marie Leak
• Michael Misha Levit, DDS
• Shelly Lloyd, MSW, LCSW
• James Arthur Loe, DMD
• Winnie Lok, RPH

• Optometrist in Peterson Afb, CO
• Providers in Peterson Afb, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.