Jonathan F Shaver, O.D.
Individual provider Active NPI Optometrist · Fayetteville, AR
NPI 1790764454 · NPPES record last updated Sep 11, 2012
Key facts
- NPI
- 1790764454
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2549 (AR)
- Practice address
- 594 E Millsap
Fayetteville, AR 72703-1345 - Phone
- (479) 442-2020
- Fax
- (479) 521-3988
- NPI assigned
- Jan 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eye Center PA
Practice addresses (Care Compare)
594 E Millsap Rd
Fayetteville, AR 72703-4096
Phone 4794422020107
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.36 of 100
- Quality
- 93.44
- Improvement activities
- 40
- Cost
- 76.6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050812000406 | AR | Practitioner - Optometry | 1850342593 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 558 | NM | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Center, PA | Optometrist | Current |
Accepting new patients |
| Jonathan F. Shaver, O.D. | Optometrist | Past |
Accepting new patients |
| Eye Deal Vision P.C. | Optometrist | Past |
Accepting new patients |
Locations
594 E Millsap Rd
Fayetteville, AR 72703
Phone (479) 442-2020
Interoperability endpoints
- jshaver@eyecenternwa.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2549 | AR | Yes |
| Optometrist | 152W00000X | 558 | NM | |
| Corneal and Contact Management Optometrist | 152WC0802X | 2549 | AR | |
| Pediatric Optometrist | 152WP0200X | 2549 | AR |
Addresses
Primary practice location
594 E Millsap
Fayetteville, AR 72703-1345
Mailing address
594 E Millsap
Fayetteville, AR 72703-2801
Phone (479) 442-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 157556722 | Medicaid | AR |
Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.