NPIMap

Organization Active NPI

Wichita Family Vision Clinic, P.a.

  • Optometrist
  • Wichita, KS
National Provider Identifier
1700978244
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
WICHITA FAMILY VISION CLINIC, P.A.
Practice address
437 N. Tyler
Wichita, KS 67212
Phone
(316) 722-1001
Fax
(316) 722-1073
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Authorized official

Name
Dr. Robert C Nelson, O.D.NPI 1023006632
Title
Owner
Phone
(316) 722-1001

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 Primary

Addresses

Primary practice location

437 N. Tyler
Wichita, KS 67212

Mailing address

437 N. Tyler
Wichita, KS 67212
Phone (316) 722-1001

Other identifiers 1

IdentifierTypeStateIssuer
017146OtherKSBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050405001351 KS Part B Supplier - Clinic/Group Practice 2365499928 Receives reassigned benefits from 8 practitioners
Practice locations: Wichita, KS
O20100930010792 KS DME Supplier - Physician - OptometristDME Supplier - Optician 2365499928 Practice locations: Wichita, KS

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
17D2065327Wichita Family Vision Clinic437 North Tyler, Wichita, KS 67212Certificate of waiverSep 8, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Wichita Family Vision Clinic437 N Tyler Rd, Wichita, KS 67212-3630(316) 722-1001 Ocular Prostheses|Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Locations

8999 W Central Ave
Ste 101
Wichita, KS 67212
Phone (316) 729-1633

Practitioners & affiliated clinicians

Practitioners 8

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": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1700978244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 N. TYLER",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67212",
            "telephone_number": "316-722-1001",
            "fax_number": "316-722-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 N. TYLER",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67212",
            "telephone_number": "316-722-1001",
            "fax_number": "316-722-1073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICHITA FAMILY VISION CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-722-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "017146",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; 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.