Specialeyes Optical, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SPECIALEYES OPTICAL, LLC

Practice address

2212 Emery St
Denton, TX 76201-1100

Phone

(940) 312-5900

Fax

(940) 312-5901

NPI assigned

Oct 16, 2018

Organization subpart

No

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

Authorized official

Name

Loretta Taylor

Title

Credentialing Coordinator

Phone

(817) 529-9949

Specialties & licenses 1

Addresses

Other identifiers 8

Tax ID family

Specialeyes Optical LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Special Eyes Optical, LLC

  • Optometrist
  • Carrollton, TX
  • NPI 1215462148
  NPD tax ID
• Specialeyes Optical, LLC

  • Optometrist
  • Mansfield, TX
  • NPI 1124573092
  NPD tax ID
• Specialeyes Optical, LLC

  • Optometrist
  • Keller, TX
  • NPI 1679028542
  NPD tax ID

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alicia Denee Derry, O.D.

  • Pediatric Optometrist
  • Fort Worth, TX
  • NPI 1801999149
  NPD (past)
• Alan Andrew Norman, MD

  • Ophthalmology Physician
  • Fort Worth, TX
  • NPI 1346219821
  NPD (past)
• Eric Alan Packwood, MD

  • Ophthalmology Physician
  • Fort Worth, TX
  • NPI 1366414773
  NPD (past)
• David F Skanchy

  • Pediatric Ophthalmology and Strabismus Specialist Physician
  • Fort Worth, TX
  • NPI 1649831462
  NPD (past)
• Sarah Madison Duff, MD

  • Pediatric Ophthalmology and Strabismus Specialist Physician
  • Louisville, KY
  • NPI 1417480153
  NPD (past)

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

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1821564964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 S HENDERSON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761041016",
            "telephone_number": "817-529-9929",
            "fax_number": "817-529-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2212 EMERY ST",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762011100",
            "telephone_number": "940-312-5900",
            "fax_number": "940-312-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALEYES OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-16",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "817-529-9949"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287401803",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "294486001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "323588905",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018440004",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166926901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375326101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145291402",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207716601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Bussey Southard, LCDC
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• Southridge Dental, LLC
• Span, Inc
• Span, Incorporated (Span Denton County)
• Spectrum Vision, PLLC
• Speech Solutions
• Andrea Spencer, APRN-NPC
• Kara Elizabeth Spencer, M.S.
• Gene Marie Sperduti, CRNA

• Optometrist in Denton, TX
• Providers in Denton, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.