Ethan Dieu Ly, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2251 Issued in TN

Practice address

330 Mayfield Dr
Suite D2
Franklin, TN 37067-7203

Phone

(615) 771-1020

Fax

(615) 771-9263

NPI assigned

Jul 20, 2006

Last updated

Oct 10, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN

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

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Calvert Opthalmology PSCGroup PAC ID 5193740959, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Calvert Opthalmology PSC

  dba Calvert Ophthalmology Center

  • Ophthalmology Physician
  • Clarksville, TN
  • NPI 1326210451
  Medicare reassignment Care Compare group NPD
• Calvert Opthalmology PSC

  dba Calvert Ophthalmology Center

  • Ophthalmology Physician
  • Hopkinsville, KY
  • NPI 1508036831
  NPD (past)

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1649290701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MAYFIELD DR",
            "address_2": "SUITE D2",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677203",
            "telephone_number": "615-771-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MAYFIELD DR",
            "address_2": "SUITE D2",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370677203",
            "telephone_number": "615-771-1020",
            "fax_number": "615-771-9263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "ETHAN",
        "middle_name": "DIEU",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "2694372",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4098341",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2507272",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luma Wellness PC
• Tiffani Lutz
• Stephen Karim Lutzak
• Luxottica of America Inc. (Lenscrafters #724)
• Luxottica of America Inc. (Target Optical #6723)
• Loc Ly, PHARM.D
• Sammantha Sue Lyman, APRN
• Carissa Lynch, PHARMD
• Julie L Lynch, RDH
• Krystal Hollingshead Lynch, A.P.R.N., R.N.

• Optometrist in Franklin, TN
• Providers in Franklin, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.