Individual provider Active NPI

Heather Swearengen Ihlo, OD

  • Optometrist
  • Center, TX
National Provider Identifier
1871089540
Registry record updated Jul 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9511 Issued in TX
Practice address
702 Louisiana St
Center, TX 75935-3672
Phone
(936) 598-8501
NPI assigned
Jul 6, 2018
Last updated
Jul 6, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9511 TX Primary

Addresses

Primary practice location

702 Louisiana St
Center, TX 75935-3672

Mailing address

702 Louisiana St
Center, TX 75935-3672
Phone (936) 598-8501

Other practice location 1

4729 NE Stallings Dr
Nacogdoches, TX 75965-1607
Phone (936) 564-2634

Other identifiers 2

IdentifierTypeStateIssuer
112471102MedicaidTX
1568468585OtherOPTOMETRY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20180813000353 TX Practitioner - Optometry 5991053621 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihlo Enterprises, PLLCGroup PAC ID 4385170877, 2 clinicians

Practice addresses (Care Compare)

702 Louisiana St
Center, TX 75935-3672
Phone (936) 598-8501

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9511TXMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
David Dixon Golden, OD, PA Optometrist CurrentSince Jul 8, 2018 Accepting new patients
Pineywoods Eye Associates P a Optometrist CurrentSince Jul 9, 2018 Accepting new patients
Pineywoods Eye Associates P a Optometrist CurrentSince Jul 9, 2018 Accepting new patients
Ihlo Enterprises, PLLC Optometrist CurrentSince Sep 9, 2024 Accepting new patients

Locations

702 Louisiana St
Center, TX 75935
Phone (409) 598-8501

4729 NE Stallings Dr
Nacogdoches, TX 75965
Phone (936) 564-2634

Organizations & group practices 4

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": "1530835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530835200000",
    "number": "1871089540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 LOUISIANA ST",
            "city": "CENTER",
            "state": "TX",
            "postal_code": "759353672",
            "telephone_number": "936-598-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 LOUISIANA ST",
            "city": "CENTER",
            "state": "TX",
            "postal_code": "759353672",
            "telephone_number": "936-598-8501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4729 NE Stallings Dr",
            "address_purpose": "LOCATION",
            "city": "Nacogdoches",
            "state": "TX",
            "postal_code": "759651607",
            "country_code": "US",
            "telephone_number": "936-564-2634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IHLO",
        "first_name": "HEATHER",
        "middle_name": "SWEARENGEN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-06",
        "last_updated": "2018-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112471102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY",
            "identifier": "1568468585",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Center, TX

Sources for this page

Verify at the official NPI Registry.