Jerry Ted Roberts, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

TX2344TG Issued in TX

Practice address

1100 Stone Rd
Suite 2020
Kilgore, TX 75662-5482

Phone

(903) 983-2020

Fax

(903) 983-4000

NPI assigned

Apr 14, 2006

Last updated

Feb 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kilgore-Gilmer Eye Care Centers, P.a.Group PAC ID 0648397299, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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

• Kilgore-Gilmer Eye Care Centers P.a.

  dba Kilgore Eye Care Center

  • Optometrist
  • Kilgore, TX
  • NPI 1184655649
  Medicare reassignment Care Compare group NPD Authorized official
• Kilgore-Gilmer-Eye Care Centers P.a.

  dba Gilmer Eye Care Center

  • Optometrist
  • Gilmer, TX
  • NPI 1104335918
  NPD
• Shawn Johnston OD PLLC

  • Optometrist
  • Gilmer, TX
  • NPI 1588547004
  NPD

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1629032768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 STONE RD",
            "address_2": "SUITE 2020",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756625482",
            "telephone_number": "903-983-2020",
            "fax_number": "903-983-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 STONE RD",
            "address_2": "SUITE 2020",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756625482",
            "telephone_number": "903-983-2020",
            "fax_number": "903-983-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JERRY",
        "middle_name": "TED",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "TX2344TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MED",
            "identifier": "410022897",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GOVERNMENT",
            "identifier": "168830001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE  CROSS BLUE SHIELD",
            "identifier": "83381E",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019369001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Elaine Reinhart, RN
• James E Repasky, MD
• Rescue Angels Adult Care (Rescue Angels Childcare Academy)
• Michelle Alvarado Reynolds, FNP-C
• Jadie Bolton Roberts, OD
• Luther Daniel Sammons, MA, LPC
• Tana Sims Sandel, PA C
• Anna Saylor, RN
• Sharla Shead
• Yolanda Sherrod

• Corneal and Contact Management Optometrist in Kilgore, TX
• Providers in Kilgore, TX by specialty
• Corneal and Contact Management Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; 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.