Individual provider Active NPI

Jonathan Bunnell, OD

  • Optometrist
  • Bowling Green, KY
National Provider Identifier
1629755160
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2336DT Issued in KY
Practice address
484 Golden Autumn Way
Bowling Green, KY 42103-6914
Phone
(270) 781-5111
NPI assigned
Jun 28, 2023
Last updated
Jun 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2336DT KY Primary

Addresses

Primary practice location

484 Golden Autumn Way
Bowling Green, KY 42103-6914

Mailing address

201 Park St
Bowling Green, KY 42101-1742

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20230804001644 KY Practitioner - Optometry 2961863097 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ky Doctors of Optometry, PLLCGroup PAC ID 0941108732, 64 clinicians
Graves Gilbert Clinic PLLCGroup PAC ID 4082511167, 207 clinicians

Practice addresses (Care Compare)

3910 Hinkleville Rd
Paducah, KY 42001-9017
Phone (270) 443-2090

484 Golden Autumn Way
Suite 201
Bowling Green, KY 42103-6914
Phone (270) 781-5111

500 Winchester Ave
Suite 810
Ashland, KY 41101-7362
Phone (606) 324-3672

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2336DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Graves Gilbert Clinic PLLC CurrentSince Jul 1, 2023 Accepting new patients
Graves Gilbert Clinic PLLC Optometrist CurrentSince Jul 1, 2023 Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist CurrentSince Oct 28, 2023 Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients

Locations

201 Park St
Bowling Green, KY 42101
Phone (270) 651-2229

484 Golden Autumn Way
Ste 201
Bowling Green, KY 42103
Phone (270) 780-2494

Interoperability endpoints

  • Direct secure messaging: jonathanbunnell@ggc.allscriptsdirect.net

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1629755160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 GOLDEN AUTUMN WAY",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421036914",
            "telephone_number": "270-781-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNNELL",
        "first_name": "JONATHAN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2336DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.