Active NPI
Lawrence Jehling, O.D.
- Optometrist
- Eureka, MO
National Provider Identifier
1588660484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T02356
- Practice address
- 54 The Legends Pkwy Ste 151
Eureka, MO 63025-3803 - Phone
- (636) 938-7010
- Fax
- (636) 938-7141
- NPI assigned
- Jun 24, 2005
- Last updated
- Oct 2, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02356 | MO | Primary |
Addresses
Primary practice location
54 The Legends Pkwy Ste 151
Eureka, MO 63025-3803
Mailing address
40 E North St
Eureka, MO 63025-1205
Phone (636) 200-4393
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410029118 | Other | MO | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T02356 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clarkson Optometry Inc | Optometrist | Past | Accepting new patients |
| Clarkson Optometry Inc | Optometrist | Past | Accepting new patients |
| Clarkson Optometry Inc | Optometrist | Past | Accepting new patients |
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": "1119571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1588660484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 E NORTH ST",
"city": "EUREKA",
"state": "MO",
"postal_code": "630251205",
"telephone_number": "636-200-4393",
"fax_number": "636-938-2650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54 THE LEGENDS PKWY STE 151",
"city": "EUREKA",
"state": "MO",
"postal_code": "630253803",
"telephone_number": "636-938-7010",
"fax_number": "636-938-7141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEHLING",
"first_name": "LAWRENCE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-24",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T02356",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410029118",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eureka, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.