Organization Active NPI

Skyview Eyecare Inc

  • Optometrist
  • Farmington, NM
National Provider Identifier
1700075843
Registry record updated Aug 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
529 Issued in NM
Legal business name
SKYVIEW EYECARE INC
Practice address
3450 E Main St
Farmington, NM 87402-5327
Phone
(505) 325-7070
Fax
(505) 325-5812
NPI assigned
Oct 15, 2007
Last updated
Aug 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2013

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

Authorized official

Name
Dr. Gordon D Russell, O.D.NPI 1902872476
Title
President
Phone
(505) 325-7070

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 529 NM Primary

Addresses

Primary practice location

3450 E Main St
Farmington, NM 87402-5327

Mailing address

3450 E Main St
Farmington, NM 87402-5327
Phone (505) 325-7070

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080806000253 NM Part B Supplier - Clinic/Group Practice 1254405426 Receives reassigned benefits from 3 practitioners
Practice locations: Farmington, NM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2125293Skyview Eyecare Inc3450 E Main, Farmington, NM 87402Certificate of waiverFeb 2, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375315200000",
    "number": "1700075843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 E MAIN ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025327",
            "telephone_number": "505-325-7070",
            "fax_number": "505-325-5812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 E MAIN ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025327",
            "telephone_number": "505-325-7070",
            "fax_number": "505-325-5812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYVIEW EYECARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2013-08-01",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-325-7070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NM",
            "license": "529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.