Kyle Jonathan Weaver, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003711A Issued in IN

Practice address

2740 Navarre Ave
Oregon, OH 43616

Phone

(419) 693-4444

Fax

(419) 697-2149

NPI assigned

Mar 15, 2012

Last updated

Aug 14, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Optometry

Education

Indiana University - School of Optometry, 2011

Medicare assignment

May accept Medicare assignment

Group practices

C J Pataluch OD PCGroup PAC ID 8022207687, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• C J Pataluch OD PC

  • Optometrist
  • Fort Wayne, IN
  • NPI 1760786503
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1609141233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 W 3RD ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454289000",
            "telephone_number": "260-729-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "43616",
            "telephone_number": "419-693-4444",
            "fax_number": "419-697-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "KYLE",
        "middle_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-15",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003711A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0233917",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #05906)
• Amy Jo Walker, AGNP
• Paul Walker, MD
• Nicholas Walla, MD
• Kori Wargacki
• Angela Jane Wells, CNM
• Denise Wells, R.PH
• Joy Wells, NP
• West Central Surgical Center-Bayside
• West Central Surgical Center-Bayside

• Optometrist in Oregon, OH
• Providers in Oregon, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; 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.
• 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.