Jacob Austin Travis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2023022831 Issued in MO

Practice address

1595 Denmark Rd
Union, MO 63084-4911

Phone

(636) 584-8989

Fax

(636) 584-0404

NPI assigned

Jun 6, 2023

Last updated

Aug 11, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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 Missouri St Louis - School of Optometry, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

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

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.

• Clarkson Optometry, Inc

  • Optometrist
  • Ellisville, MO
  • NPI 1497155345
  Medicare reassignment Care Compare group NPD
• Clarkson Optometry Inc

  dba Clarkson Eyecare

  • Optometrist
  • Elk River, MN
  • NPI 1952992976
  NPD
• Clarkson Optometry Inc

  dba Clarkson Eyecare

  • Optometrist
  • Arnold, MO
  • NPI 1053364729
  NPD (past)
• Clarkson Optometry Inc

  dba Clarkson Eyecare

  • Optometrist
  • Fenton, MO
  • NPI 1114970779
  NPD (past)
• Diane G. Wilson, OD & Associates, PC

  dba Arnold EyeCare Center

  • Optometrist
  • Arnold, MO
  • NPI 1770619637
  NPD (past)

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

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1639863392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207158",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207158",
            "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": "1595 DENMARK RD",
            "city": "UNION",
            "state": "MO",
            "postal_code": "630844911",
            "telephone_number": "636-584-8989",
            "fax_number": "636-584-0404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3071 Phoenix Center Dr",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "MO",
            "postal_code": "630905690",
            "country_code": "US",
            "telephone_number": "636-777-2345",
            "fax_number": "636-777-2115",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "54 The Legends Pkwy Ste 151",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "MO",
            "postal_code": "630253803",
            "country_code": "US",
            "telephone_number": "636-938-7010",
            "fax_number": "636-938-7141",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2698 Gravois Rd",
            "address_purpose": "LOCATION",
            "city": "High Ridge",
            "state": "MO",
            "postal_code": "630492508",
            "country_code": "US",
            "telephone_number": "636-677-1166",
            "fax_number": "636-677-1324",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "699 Gravois Bluffs Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Fenton",
            "state": "MO",
            "postal_code": "630267745",
            "country_code": "US",
            "telephone_number": "636-349-3005",
            "fax_number": "636-305-1021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2404 Taylor Rd",
            "address_purpose": "LOCATION",
            "city": "Wildwood",
            "state": "MO",
            "postal_code": "630401222",
            "country_code": "US",
            "telephone_number": "636-458-8787",
            "fax_number": "636-405-0629",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "330 W Osage St",
            "address_purpose": "LOCATION",
            "city": "Pacific",
            "state": "MO",
            "postal_code": "630691331",
            "country_code": "US",
            "telephone_number": "636-271-4500",
            "fax_number": "636-271-6940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14842 Manchester Rd",
            "address_purpose": "LOCATION",
            "city": "Ballwin",
            "state": "MO",
            "postal_code": "630114620",
            "country_code": "US",
            "telephone_number": "636-557-2020",
            "fax_number": "636-557-4020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "730 S Kirkwood Rd",
            "address_purpose": "LOCATION",
            "city": "Kirkwood",
            "state": "MO",
            "postal_code": "631225929",
            "country_code": "US",
            "telephone_number": "314-821-2626",
            "fax_number": "314-821-4189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRAVIS",
        "first_name": "JACOB",
        "middle_name": "AUSTIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2023022831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Lynn Thompson, LPC
• Timothy S. Ellefson D.C.,P.C. (Union Chiropractic Center)
• Jessica N Tipton, LCSW
• Darrion Johnnell Tobias, LPC
• Leslie Tomlin
• Ashley D Tucker, LPN
• Toni Louise Turigliatto, LPC
• Union Community Ambulance District
• Union Community Ambulance District (Union Ambulance District)
• Union Court Residential, LLC (Willow Brooke)

• Optometrist in Union, MO
• Providers in Union, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; 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.