Kory Lynn Shaw, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP100509 Issued in ID

Practice address

844 Shoshone St E
Twin Falls, ID 83301-6336

Phone

(208) 734-9800

Fax

(208) 734-9433

NPI assigned

Sep 15, 2020

Last updated

Sep 15, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern California College of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyecenter PAGroup PAC ID 4486672565, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eyecenter PA

  dba Hailey Eyecenter

  • Optometrist
  • Hailey, ID
  • NPI 1154418366
  Medicare reassignment Care Compare group NPD
• Eyecenter PA

  dba Twin Falls Eyecenter

  • Optometrist
  • Twin Falls, ID
  • NPI 1881781094
  NPD
• Eyecenter PA

  dba Ketchum Eyecenter

  • Optometrist
  • Ketchum, ID
  • NPI 1174632244
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1750996740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "844 SHOSHONE ST E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016336",
            "telephone_number": "208-734-9800",
            "fax_number": "208-734-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "844 SHOSHONE ST E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016336",
            "telephone_number": "208-734-9800",
            "fax_number": "208-734-9433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 N 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Hailey",
            "state": "ID",
            "postal_code": "833338913",
            "country_code": "US",
            "telephone_number": "208-788-4120",
            "fax_number": "208-788-3571",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 S Lincoln Ave",
            "address_purpose": "LOCATION",
            "city": "Jerome",
            "state": "ID",
            "postal_code": "833382624",
            "country_code": "US",
            "telephone_number": "208-324-4363",
            "fax_number": "208-324-8948",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "180 1st Ave North",
            "address_purpose": "LOCATION",
            "city": "Ketchum",
            "state": "ID",
            "postal_code": "833406129",
            "country_code": "US",
            "telephone_number": "208-726-0138",
            "fax_number": "208-726-3363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KORY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP100509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Kurt Seppi, M.D.
• Serenidad Psychology LLC
• Mendizje Serpa
• SH1 Midstate MGMT LLC
• Heather Shaw
• Kylee Shaw, PA
• Michael Shaw, DO
• Samuel Teagan Shaw, FNP-C
• Thomas Domingo Shaw, P.T.
• Stephanie Ann Shawver, AGACNP-BC

• Optometrist in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.