Active NPI
Jimmy Lee Powell
- Optician
- Coffeyville, KS
National Provider Identifier
1760450449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- Practice address
- 1411 W 4TH St
Coffeyville, KS 67337-3300 - Phone
- (620) 251-0050
- Fax
- (620) 251-0050
- NPI assigned
- Mar 9, 2006
- 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 | Primary |
Addresses
Primary practice location
1411 W 4TH St
Coffeyville, KS 67337-3300
Mailing address
1411 W 4TH St
Coffeyville, KS 67337-3300
Phone (620) 251-0050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100095230A | Medicaid | KS | |
| OP7674 | Other | KS | BLUE CROSS & BLUE SHIELD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424822400000",
"number": "1760450449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 W 4TH ST",
"city": "COFFEYVILLE",
"state": "KS",
"postal_code": "673373300",
"telephone_number": "620-251-0050",
"fax_number": "620-251-0050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 W 4TH ST",
"city": "COFFEYVILLE",
"state": "KS",
"postal_code": "673373300",
"telephone_number": "620-251-0050",
"fax_number": "620-251-0050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "JIMMY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-09",
"last_updated": "2015-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100095230A",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "OP7674",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coffeyville, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.