Amanda Leanne Moore-Elcyzyn, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100499 Issued in ID

Practice address

113 W Carpenter St
Benton, AR 72015-3317

Phone

(501) 778-2363

Fax

(501) 778-5329

NPI assigned

Jun 29, 2006

Last updated

Sep 9, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Amanda Leanne Moore Former name

Medicare fee-for-service enrollment

Enrolled in AR, ID2 enrollments

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 2

Specialty

Optometry

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boise Vision Care, P.a.Group PAC ID 4284768656, 3 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.

• Boise Vision Care, P.a.

  • Optometrist
  • Boise, ID
  • NPI 1134295116
  Medicare reassignment Care Compare group NPD
• James Eyecare Center, Inc

  • Optometrist
  • Little Rock, AR
  • NPI 1740405786
  Medicare reassignment NPD
• Ada Vision Center P.a.

  • Optometrist
  • Boise, ID
  • NPI 1407869589
  Medicare reassignment NPD
• SS Eye Group, PLLC

  dba Teague Eye & Vision Clinic

  • Optometrist
  • Little Rock, AR
  • NPI 1992232102
  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1780612499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1926 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837023957",
            "telephone_number": "208-336-2020",
            "fax_number": "208-384-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W CARPENTER ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153317",
            "telephone_number": "501-778-2363",
            "fax_number": "501-778-5329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1926 W State St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837023957",
            "country_code": "US",
            "telephone_number": "208-336-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE-ELCYZYN",
        "first_name": "AMANDA",
        "middle_name": "LEANNE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2566",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE #",
            "identifier": "49956",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161893722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "MOORE",
            "middle_name": "LEANNE",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexis Montalvo
• Jessica Montgomery, CMP
• Michael R Montgomery, RECOVERY ASSISTANT
• Ruby Moody, RECOVERY ASSISTANT
• Moonlight Mental Health
• Delaina Moore
• Jason Moore, CMP
• Mary Moore
• Ramon Moore, RECOVERY ASSISTANT
• Rhonda Moore

• Optometrist in Benton, AR
• Providers in Benton, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.