NPIMap

Organization Active NPI

Stith Vision Center Inc.

  • Optometrist
  • Poplar Bluff, MO
National Provider Identifier
1760668677
Registry record updated Apr 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T02821 Issued in MO
Legal business name
STITH VISION CENTER INC.
Practice address
1916 N Westwood Blvd
Poplar Bluff, MO 63901-2808
Phone
(573) 686-1164
Fax
(573) 686-5072
NPI assigned
Jan 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2009

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

Authorized official

Name
Dr. Teri L Page, O.D.NPI 1528123056
Title
Optometrist
Phone
(573) 686-1164

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: 193400000X SINGLE SPECIALTY GROUP 152W00000X T02821 MO Primary

Addresses

Primary practice location

1916 N Westwood Blvd
Poplar Bluff, MO 63901-2808

Mailing address

1916 N Westwood Blvd
Poplar Bluff, MO 63901-2808
Phone (573) 686-1164

Other names 1

  • Pearle Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930027052 MO DME Supplier - Physician - OptometristDME Supplier - Optician 5294854683 Practice locations: Poplar Bluff, MO
O20101129000062 MO Part B Supplier - Clinic/Group Practice 5294854683 Receives reassigned benefits from 1 practitioner
Practice locations: Poplar Bluff, MO

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
Pearle Vision Center1916 N Westwood Blvd, Poplar Bluff, MO 63901-2808(573) 686-1164 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Aug 1, 2002

National Provider Directory

National Provider Directory

Locations

1916 N Westwood Blvd
Poplar Bluff, MO 63901
Phone (573) 686-1164

Practitioners & affiliated clinicians

Practitioners 1

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": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240444800000",
    "number": "1760668677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012808",
            "telephone_number": "573-686-1164",
            "fax_number": "573-686-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012808",
            "telephone_number": "573-686-1164",
            "fax_number": "573-686-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STITH VISION CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2009-04-23",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "573-686-1164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearle Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; 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.