NPIMap

Organization Active NPI

Southern Hills Eye Care PC

  • Optometrist
  • Sioux City, IA
National Provider Identifier
1811084353
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
IA1725 Issued in IA
Legal business name
SOUTHERN HILLS EYE CARE PC
Practice address
4600 Singing Hills Blvd
Sioux City, IA 51106-9702
Phone
(712) 271-4600
Fax
(712) 271-4604
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

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

Authorized official

Name
Dennis Roy Vannatta, ODNPI 1144212358
Title
President
Phone
(712) 271-4600

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 IA1725 IA Primary

Addresses

Primary practice location

4600 Singing Hills Blvd
Sioux City, IA 51106-9702

Mailing address

4600 Singing Hills Blvd
Sioux City, IA 51106-9702
Phone (712) 271-4600

Other identifiers 1

IdentifierTypeStateIssuer
0176289MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040324000686 IA Part B Supplier - Clinic/Group Practice 2365333614 Receives reassigned benefits from 2 practitioners
Practice locations: Sioux City, IA
O20100930015962 IA DME Supplier - Physician - OptometristDME Supplier - Optician 2365333614 Practice locations: Sioux City, IA

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
Southern Hills Eye Care PC4600 Singing Hills Blvd, Sioux City, IA 51106-9702(712) 271-4600 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Locations

4600 Singing Hills Blvd
Sioux City, IA 51106
Phone (712) 271-4600

Practitioners & affiliated clinicians

Practitioners 6

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1811084353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 SINGING HILLS BLVD",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511069702",
            "telephone_number": "712-271-4600",
            "fax_number": "712-271-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 SINGING HILLS BLVD",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511069702",
            "telephone_number": "712-271-4600",
            "fax_number": "712-271-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HILLS EYE CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "VANNATTA",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-271-4600",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "IA1725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0176289",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; 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.