NPIMap

Organization Active NPI

Vision Specialists of Council Bluffs LLC

  • Optometrist
  • Council Bluffs, IA
National Provider Identifier
1831377084
Registry record updated Jul 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
VISION SPECIALISTS OF COUNCIL BLUFFS LLC
Practice address
2514 W Broadway
Council Bluffs, IA 51501-3509
Phone
(712) 322-3097
Fax
(712) 322-4130
NPI assigned
Feb 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2018

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

Authorized official

Name
Kyle Cheatham, ODNPI 1568568384
Title
Owner
Phone
(712) 322-3097

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 Primary

Addresses

Primary practice location

2514 W Broadway
Council Bluffs, IA 51501-3509

Mailing address

2514 W Broadway
Council Bluffs, IA 51501-3509
Phone (712) 322-3097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080520000072 IA Part B Supplier - Clinic/Group Practice 4183793938 Receives reassigned benefits from 6 practitioners
Practice locations: Council Bluffs, IA

National Provider Directory

National Provider Directory

Locations

1505 W Broadway
Ste 3
Council Bluffs, IA 51501
Phone (712) 322-3097

1505 W Broadway
Ste 35
Council Bluffs, IA 51501
Phone (712) 322-3097

2514 W Broadway
Council Bluffs, IA 51501
Phone (712) 227-6340

2600 W Broadway
Ste 2
Council Bluffs, IA 51501
Phone (712) 322-3097

1505 W Broadway
#35
Council Bluffs, IA 51501
Phone (712) 322-3097

3910 N Ridge Rd
Wichita, KS 67205
Phone (316) 721-2701

3606 N 156th St
Ste 105
Omaha, NE 68116
Phone (402) 205-0754

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1202428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532995200000",
    "number": "1831377084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013509",
            "telephone_number": "712-322-3097",
            "fax_number": "712-322-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2514 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013509",
            "telephone_number": "712-322-3097",
            "fax_number": "712-322-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION SPECIALISTS OF COUNCIL BLUFFS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-08",
        "last_updated": "2018-07-31",
        "status": "A",
        "authorized_official_last_name": "CHEATHAM",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-322-3097",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; 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.

Verify at the official NPI Registry.