NPIMap

Organization Active NPI

Maydew Thibault Optometry LLC

  • Optometrist
  • Medicine Lodge, KS
National Provider Identifier
1720132715
Registry record updated May 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MAYDEW THIBAULT OPTOMETRY LLC
Practice address
604 N Walnut
Medicine Lodge, KS 67104
Phone
(620) 886-3222
Fax
(620) 886-3541
NPI assigned
Jan 23, 2007
Last updated
May 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2013

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

Authorized official

Name
Dr. Troy O Maydew, ODNPI 1144396458
Title
Member Manager
Phone
(620) 886-3222

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
Optometrist 152W00000X Primary

Addresses

Primary practice location

604 N Walnut
Medicine Lodge, KS 67104

Mailing address

PO Box 129
604 N Walnut
Medicine Lodge, KS 67104
Phone (620) 886-3222

Other identifiers 1

IdentifierTypeStateIssuer
20051988BMedicaidKS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040915000796 KS Part B Supplier - Clinic/Group Practice 9436126703 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kingman, KS; Medicine Lodge, KS; Pratt, KS
O20100930070019 KS DME Supplier - Physician - Optometrist 9436126703 Practice locations: Medicine Lodge, KS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Maydew Thibault Optometry LLC604 N Walnut St, Medicine Lodge, KS 67104-1115(620) 886-3222 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1999

National Provider Directory

National Provider Directory
Tax ID family
Maydew Thibault Optometry LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

604 N Walnut St
Medicine Lodge, KS 67104
Phone (620) 886-3222

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": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1720132715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "address_2": "604 N WALNUT",
            "city": "MEDICINE LODGE",
            "state": "KS",
            "postal_code": "67104",
            "telephone_number": "620-886-3222",
            "fax_number": "620-886-3541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N WALNUT",
            "city": "MEDICINE LODGE",
            "state": "KS",
            "postal_code": "67104",
            "telephone_number": "620-886-3222",
            "fax_number": "620-886-3541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYDEW THIBAULT OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "MAYDEW",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "620-886-3222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20051988B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medicine Lodge, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.