Active NPI
Jimmie Tantillo Phelps, PSC
- Optician
- Richmond, KY
National Provider Identifier
1740440742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 325
- Practice address
- 205 Geri LN
Richmond, KY 40475-2359 - Phone
- (859) 623-4267
- Fax
- (859) 623-4249
- NPI assigned
- Jun 12, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 325 | KY | Primary |
Addresses
Primary practice location
205 Geri LN
Richmond, KY 40475-2359
Mailing address
205 Geri LN
Richmond, KY 40475-2359
Phone (859) 623-4267
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52800919 | Medicaid | KY | |
| OP0933 | Other | KY | EYE MED |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 325 | KY | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1740440742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 GERI LN",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404752359",
"telephone_number": "859-623-4267",
"fax_number": "859-623-4249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 GERI LN",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404752359",
"telephone_number": "859-623-4267",
"fax_number": "859-623-4249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELPS",
"first_name": "JIMMIE",
"middle_name": "TANTILLO",
"name_prefix": "Mr.",
"credential": "PSC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-12",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "KY",
"license": "325",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52800919",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYE MED",
"identifier": "OP0933",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.