Organization Active NPI

BWB Eye Care PLLC

  • Optometrist
  • Fort Worth, TX
National Provider Identifier
1710622345
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BWB EYE CARE PLLC
Practice address
1512 8TH Ave Ste 100
Fort Worth, TX 76104-4150
Phone
(214) 773-9939
NPI assigned
Apr 28, 2022
Last updated
Apr 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Ivan B Bank, ODNPI 1194706861
Title
MBR
Phone
(214) 773-9939

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Corneal and Contact Management Optometrist 152WC0802X NU

Addresses

Primary practice location

1512 8TH Ave Ste 100
Fort Worth, TX 76104-4150

Mailing address

1512 8TH Ave Ste 100
Fort Worth, TX 76104-4150

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address insight@insightfortworth.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220615000281 TX Part B Supplier - Clinic/Group Practice 4789063173 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

1512 8th Ave
Ste 100
Fort Worth, TX 76104
Phone (817) 759-9200

Practitioners & affiliated clinicians

Practitioners 3

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": "1651104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1710622345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 8TH AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 8TH AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044150",
            "telephone_number": "214-773-9939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BWB EYE CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-28",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "BANK",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "214-773-9939",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "insight@insightfortworth.com",
            "affiliation": "N",
            "endpointDescription": "office email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1512 8th Ave Ste 100",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761044150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.