Individual provider Active NPI

Floyd Galloway Betts III, O.D.

  • Optometrist
  • Tyler, TX
National Provider Identifier
1801923701
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
02492TG Issued in TX
Practice address
136 Shelley Dr
Tyler, TX 75701-8723
Phone
(903) 561-8686
Fax
(903) 581-1518
NPI assigned
Feb 27, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 02492TG TX Primary

Addresses

Primary practice location

136 Shelley Dr
Tyler, TX 75701-8723

Mailing address

136 Shelley Dr
Tyler, TX 75701-8723
Phone (903) 561-8686

Other identifiers 7

IdentifierTypeStateIssuer
48849OtherTXDAVIS VISION
552688OtherTXNVA
093146101MedicaidTX
924268OtherTXBLOCK VISION
410021637OtherTXRAILROAD MEDICARE
81382QOtherTXBLUECROSSBLUESHIELD
08379OtherTXSPECTERA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120627000418 TX Practitioner - Optometry 8325203243 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
02492TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Larry M Chism PC Optometrist CurrentSince Feb 1, 2012 Accepting new patients

Locations

6801 S Broadway Ave
Ste 100
Tyler, TX 75703
Phone (903) 561-2000

136 Shelley Dr
Tyler, TX 75701
Phone (903) 561-8686

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492560000000",
    "number": "1801923701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 SHELLEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018723",
            "telephone_number": "903-561-8686",
            "fax_number": "903-581-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 SHELLEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018723",
            "telephone_number": "903-561-8686",
            "fax_number": "903-581-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTS",
        "first_name": "FLOYD",
        "middle_name": "GALLOWAY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2017-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "02492TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "48849",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "552688",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093146101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "924268",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410021637",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "81382Q",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "08379",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.