Individual provider Active NPI

Parag Kanitkar, OD

  • Optometrist
  • Bristol, TN
National Provider Identifier
1689745218
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD1625 Issued in TN
Practice address
1262 Volunteer Pkwy
Bristol, TN 37620-4628
Phone
(423) 989-3737
Fax
(423) 989-9513
NPI assigned
Nov 13, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD1625 TN Primary

Addresses

Primary practice location

1262 Volunteer Pkwy
Bristol, TN 37620-4628

Mailing address

11103 West Ave
Suite 6
San Antonio, TX 78213-1370
Phone (210) 524-6663

Other identifiers 1

IdentifierTypeStateIssuer
3941263MedicaidTN

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041207000501 TN Practitioner - Optometry 6800852328 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OD1625TNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Mark Lynn & Associates, PLLC Optometrist CurrentSince Jan 1, 2021 Accepting new patients
TN Doctors of Optometry, PLLC Optometrist CurrentSince Feb 6, 2022 Accepting new patients
TN Doctors of Optometry, PLLC Optometrist CurrentSince Feb 6, 2022 Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist CurrentSince Jan 1, 2021 Accepting new patients

Locations

1262 Volunteer Pkwy
Bristol, TN 37620
Phone (423) 989-3737

1008 Indian Trail Dr
Kingsport, TN 37660
Phone (423) 247-2020

1701 Gallatin Pike N
Madison, TN 37115
Phone (615) 868-2000

2012 Crossings Cir
Ste B
Spring Hill, TN 37174
Phone (931) 489-9151

175 E Houston St
San Antonio, TX 78205
Phone (210) 524-6982

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1689745218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "address_2": "SUITE 6",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131370",
            "telephone_number": "210-524-6663",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 VOLUNTEER PKWY",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376204628",
            "telephone_number": "423-989-3737",
            "fax_number": "423-989-9513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANITKAR",
        "first_name": "PARAG",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD1625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3941263",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

Verify at the official NPI Registry.