NPIMap

Organization Active NPI

Martha Ellen Myers, O.D. PA

  • Optometrist
  • Fayetteville, AR
National Provider Identifier
1649289265
Registry record updated Mar 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2490 Issued in AR
Legal business name
MARTHA ELLEN MYERS, O.D. PA
Practice address
2875 W 6TH St
Fayetteville, AR 72704-7625
Phone
(479) 527-9790
Fax
(479) 527-9792
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2011

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

Authorized official

Name
Dr. Martha Ellen Myers, O.D.NPI 1265463483
Title
President
Phone
(479) 527-9790

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2490 AR Primary

Addresses

Primary practice location

2875 W 6TH St
Fayetteville, AR 72704-7625

Mailing address

2875 W 6TH St
Fayetteville, AR 72704-7625
Phone (479) 527-9790

Other identifiers 1

IdentifierTypeStateIssuer
154135722MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615001384 AR Part B Supplier - Clinic/Group Practice 1153305701 Receives reassigned benefits from 4 practitioners
Practice locations: Fayetteville, AR

National Provider Directory

National Provider Directory

Locations

2875 W Martin Luther King Jr Blvd
Fayetteville, AR 72704
Phone (479) 521-4350

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301011200000",
    "number": "1649289265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2875 W 6TH ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047625",
            "telephone_number": "479-527-9790",
            "fax_number": "479-527-9792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 W 6TH ST",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047625",
            "telephone_number": "479-527-9790",
            "fax_number": "479-527-9792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTHA ELLEN MYERS, O.D. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-03-25",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-527-9790",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154135722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.