NPIMap

Organization Active NPI

Maydew Thibault Optometry LLC

  • Optometrist
  • Pratt, KS
National Provider Identifier
1740343276
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
216 S Oak St
Pratt, KS 67124-2721
Phone
(620) 672-5934
Fax
(620) 672-3550
NPI assigned
Dec 18, 2006
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
Managing Member
Phone
(620) 672-5934

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: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

216 S Oak St
Pratt, KS 67124-2721

Mailing address

PO Box 1024
216 S. Oak St.
Pratt, KS 67124-1024
Phone (620) 672-5934

Other identifiers 1

IdentifierTypeStateIssuer
200966630AMedicaidKS

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
Practice locations: Kingman, KS; Medicine Lodge, KS; Pratt, KS
O20100930017763 KS DME Supplier - Physician - Optometrist 9436126703 Practice locations: Pratt, 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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2215236Maydew Thibault Optometry LLC216 South Oak, Pratt, KS 67124Certificate of waiverMar 1, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Maydew Thibault Optometry, LLC216 S Oak St, Pratt, KS 67124-2721(620) 672-5934 Prosthetic Lenses: Conventional Eyeglasses 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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1740343276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1024",
            "address_2": "216 S. OAK ST.",
            "city": "PRATT",
            "state": "KS",
            "postal_code": "671241024",
            "telephone_number": "620-672-5934",
            "fax_number": "620-672-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 S OAK ST",
            "city": "PRATT",
            "state": "KS",
            "postal_code": "671242721",
            "telephone_number": "620-672-5934",
            "fax_number": "620-672-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYDEW THIBAULT OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "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": "MANAGING MEMBER",
        "authorized_official_telephone_number": "620-672-5934",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200966630A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pratt, 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.