Individual provider Active NPI

John A Walters, OD

  • Optometrist
  • Madison, AL
National Provider Identifier
1639142789
Registry record updated Nov 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S563TA091 Issued in AL
Practice address
7880 Old Madison Pike
Madison, AL 35758-1435
Phone
(256) 772-8711
Fax
(256) 772-8738
NPI assigned
Feb 9, 2006
Last updated
Nov 15, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X S563TA091 AL Primary

Addresses

Primary practice location

7880 Old Madison Pike
Madison, AL 35758-1435

Mailing address

15933 Clayton Rd
Suite 201
Ballwin, MO 63011-2172
Phone (636) 200-4393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20100921000695 AL Practitioner - Optometry 7012032576 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S563TA091ALMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecare Associates, Inc. CurrentSince May 10, 2017 Accepting new patients
Eyecare Associates, Inc. Optometrist Current Accepting new patients
Eyecare Associates, Inc. Optometrist CurrentSince May 10, 2017 Accepting new patients

Locations

7880 Old Madison Pike
Madison, AL 35758
Phone (256) 772-8711

Interoperability endpoints

  • Direct secure messaging: jwalters@direct.eyecare-partners.com

Organizations & group practices 3

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1639142789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15933 CLAYTON RD",
            "address_2": "SUITE 201",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112172",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7880 OLD MADISON PIKE",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357581435",
            "telephone_number": "256-772-8711",
            "fax_number": "256-772-8738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S563TA091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, AL

Sources for this page

Verify at the official NPI Registry.