Trussell L Thane

Primary specialty

OptometristTaxonomy code 152W00000X

License

04720TG Issued in TX

Practice address

1501 Columbia St
Stamford, TX 79553-6882

Phone

(325) 773-2083

Fax

(325) 773-2526

NPI assigned

Apr 3, 2006

Last updated

Feb 26, 2015By 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 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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Abilene Advanced Eyecare Inc.

  • Optometrist
  • Abilene, TX
  • NPI 1104001643
  NPD (past)

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424908800000",
    "number": "1609838101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 COLUMBIA ST",
            "city": "STAMFORD",
            "state": "TX",
            "postal_code": "795536882",
            "telephone_number": "325-773-2083",
            "fax_number": "325-773-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 COLUMBIA ST",
            "city": "STAMFORD",
            "state": "TX",
            "postal_code": "795536882",
            "telephone_number": "325-773-2083",
            "fax_number": "325-773-2526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THANE",
        "first_name": "TRUSSELL",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2015-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "04720TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126535701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stamford Managementco LLC (Stamford Residence and Post Acute Center)
• Stamford TX Management LLC (Stamford Residence and Rehabilitation Center)
• Stamford Vip
• Holly Stocks
• Teakwood Manor, LLC
• Trussell Thane OD
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-1257)

• Optometrist in Stamford, TX
• Providers in Stamford, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.