NPIMap

Organization Active NPI

Custom Vision, Inc.

  • Optometrist
  • Lees Summit, MO
National Provider Identifier
1619004280
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TO2926 Issued in MO
Legal business name
CUSTOM VISION, INC.
Practice address
3660 NE Ralph Powell Rd
Lees Summit, MO 64064-2357
Phone
(816) 524-7400
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Authorized official

Name
Dr. Scott Adrian Drake, O.D.
Title
Owner
Phone
(816) 524-7400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TO2926 MO Primary

Addresses

Primary practice location

3660 NE Ralph Powell Rd
Lees Summit, MO 64064-2357

Mailing address

3660 NE Ralph Powell Rd
Lees Summit, MO 64064-2357
Phone (816) 524-7400

Other names 1

  • Custom Eyes Doing business as

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: customeyesld@customeyeskc1.eyefinity-direct.com
  • Direct secure messaging: ldrake@customeyeskc1.eyefinity-direct.com
  • Direct secure messaging: sdrake@customeyeskc1.eyefinity-direct.com
  • Direct secure messaging: agenilo@customeyeskc1.eyefinity-direct.com

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1619004280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642357",
            "telephone_number": "816-524-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642357",
            "telephone_number": "816-524-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM VISION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "ADRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-524-7400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO2926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Eyes",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custom Eyes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lees Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.