Samuel L Erwin
Individual provider Active NPI Optometrist · Corning, AR
NPI 1629082250 · NPPES record last updated Aug 23, 2013
Key facts
- NPI
- 1629082250
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2293 (AR)
- Practice address
- 609 N Missouri Ave
Corning, AR 72422-1617 - Phone
- (870) 857-6556
- Fax
- (870) 857-3787
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
609 N Missouri Ave
Corning, AR 72422-1617
Phone (870) 857-6556
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 83 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040121000265 | AR | Practitioner - Optometry | 3971405002 | Practice locations: Corning, AR |
| O20130816000721 | AR | DME Supplier - Physician - Optometrist | 0547402786 | Practice locations: Corning, AR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2293 | AR | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2293 | AR | Yes |
Addresses
Primary practice location
609 N Missouri Ave
Corning, AR 72422-1617
Mailing address
PO Box 37
Corning, AR 72422-0037
Phone (870) 857-6556
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 291690 | Other | AR | PTAN |
| 101510722 | Medicaid | AR |
Other providers in Corning, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.