Individual provider Active NPI

Josephine Olutola Ibironke, O.D.

  • Optometrist
  • Pikeville, KY
National Provider Identifier
1831145770
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2041DT Issued in KY
Practice address
147 Sycamore St
Pikeville, KY 41501-9118
Phone
(606) 218-5525
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA1877 MD
Optometrist 152W00000X 2041DT KY Primary

Addresses

Primary practice location

147 Sycamore St
Pikeville, KY 41501-9118

Mailing address

147 Sycamore St
Pikeville, KY 41501-9118
Phone (606) 218-5525

Other practice location 1

911 Bypass Rd Bldg A
Pikeville, KY 41501-1689
Phone (606) 430-2208

Other identifiers 1

IdentifierTypeStateIssuer
405879800MedicaidMD

Other names 1

  • Josephine Owoeye Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jibironke28642@PIKEVILLEDIRECT.ORG Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20161201001849 KY Practitioner - Optometry 5193624831 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2041DTKYMDOptometrist
TA1877MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Pikeville Medical Center Inc. Optometrist CurrentSince Nov 1, 2016 Accepting new patients
University of Pikeville Optometrist CurrentSince Nov 11, 2018 Accepting new patients
Pikeville Medical Center Inc CurrentSince Nov 1, 2016 Accepting new patients

Locations

41 Triangle St
Martin, KY 41649
Phone (606) 218-5540

184 S Mayo Trl
Pikeville, KY 41501
Phone (606) 430-2213

911 Bypass Rd
Bldg A
Pikeville, KY 41501
Phone (606) 430-2201

147 Sycamore St
#858
Pikeville, KY 41501

147 Sycamore St
Pikeville, KY 41501
Phone (606) 218-5250

Interoperability endpoints

  • Direct secure messaging: jibironke28642@pikevilledirect.org

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1831145770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 SYCAMORE ST",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415019118",
            "telephone_number": "606-218-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 SYCAMORE ST",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415019118",
            "telephone_number": "606-218-5525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Bypass Rd Bldg A",
            "address_purpose": "LOCATION",
            "city": "Pikeville",
            "state": "KY",
            "postal_code": "415011689",
            "country_code": "US",
            "telephone_number": "606-430-2208",
            "fax_number": "606-218-7508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBIRONKE",
        "first_name": "JOSEPHINE",
        "middle_name": "OLUTOLA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1877",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2041DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405879800",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jibironke28642@PIKEVILLEDIRECT.ORG",
            "affiliation": "N",
            "endpointDescription": "Direct address for ccda",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Standard direct functionality",
            "address_1": "911 Bypass Rd Bldg A",
            "city": "Pikeville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "415011689",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JOSEPHINE",
            "last_name": "OWOEYE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pikeville, KY

Sources for this page

Verify at the official NPI Registry.