Active NPI
Ben Philbert Cannon, O.D.
- Optometrist
- Mason City, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 074027
- Practice address
- 615 Monroe Ave
Mason City, IA 50401 - Phone
- (641) 424-8271
- NPI assigned
- Oct 19, 2011
- Last updated
- Dec 5, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3413 | MN | |
| Optometrist | 152W00000X | 074027 | IA | Primary |
Addresses
Primary practice location
615 Monroe Ave
Mason City, IA 50401
Mailing address
615 Monroe Ave
Mason City, IA 50401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA, MN, UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 3
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 074027 | IA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Past | Accepting new patients |
| Shoptikal LLC | Optometrist | Past | Accepting new patients |
Locations
3570 4th St SW
Ste 400
Mason City, IA 50401
Phone (641) 424-8271
615 S Monroe Ave
Mason City, IA 50401
Phone (515) 424-8271
615 S Monroe Ave
#52
Mason City, IA 50401
Phone (641) 424-8271
1001 Highway 15 S
Fairmont, MN 56031
Phone (507) 238-9488
2843 S 5600 W
Ste 110
West Valley City, UT 84120
Phone (801) 967-6300
Organizations & group practices 6
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.
-
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- NPI 1467311142
Optometrist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1770868820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 MONROE AVE",
"city": "MASON CITY",
"state": "IA",
"postal_code": "50401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 MONROE AVE",
"city": "MASON CITY",
"state": "IA",
"postal_code": "50401",
"telephone_number": "641-424-8271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "BEN",
"middle_name": "PHILBERT",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-19",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "3413",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "074027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mason City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.