Active NPI
Envision Eye Care LLC
- Optometrist
- Fort Wayne, IN
National Provider Identifier
1811280076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18003334
- Legal business name
- ENVISION EYE CARE LLC
- Practice address
- 14413 Illinois Rd
Ste. C
Fort Wayne, IN 46814-9714 - Phone
- (260) 616-0184
- Fax
- (855) 271-9517
- NPI assigned
- May 20, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Christina Mummert, O.D.
- Title
- Member/President
- Phone
- (260) 616-0184
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18003334 | IN | Primary |
Addresses
Primary practice location
14413 Illinois Rd
Ste. C
Fort Wayne, IN 46814-9714
Mailing address
14413 Illinois Rd
Ste. C
Fort Wayne, IN 46814-9714
Phone (260) 616-0184
Other names 1
- Envision Eye Care and Eyewear Gallery
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110729000065 | IN | Part B Supplier - Clinic/Group Practice | 3375711799 |
Receives reassigned benefits from 2 practitioners Practice locations: Fort Wayne, IN |
National Provider Directory
National Provider DirectoryLocations
14413 Illinois Rd
Ste C
Fort Wayne, IN 46814
Phone (260) 402-8382
Practitioners & affiliated clinicians
Practitioners 2
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": "1305849600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1385942400000",
"number": "1811280076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14413 ILLINOIS RD",
"address_2": "STE. C",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468149714",
"telephone_number": "260-616-0184",
"fax_number": "855-271-9517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14413 ILLINOIS RD",
"address_2": "STE. C",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468149714",
"telephone_number": "260-616-0184",
"fax_number": "855-271-9517"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ENVISION EYE CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2011-05-20",
"last_updated": "2013-12-02",
"status": "A",
"authorized_official_last_name": "MUMMERT",
"authorized_official_first_name": "CHRISTINA",
"authorized_official_title_or_position": "MEMBER/PRESIDENT",
"authorized_official_telephone_number": "260-616-0184",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "IN",
"license": "18003334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Envision Eye Care and Eyewear Gallery",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.