Active NPI
John E Taylor, O.D.
- Optometrist
- Conrad, MT
National Provider Identifier
1871661355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- MT345
- Practice address
- 403 S Delaware St
Conrad, MT 59425-2310 - Phone
- (406) 278-5331
- Fax
- (406) 278-7379
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | MT345 | MT | Primary |
Addresses
Primary practice location
403 S Delaware St
Conrad, MT 59425-2310
Mailing address
403 S Delaware St
Conrad, MT 59425-2310
Phone (406) 278-5331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048-9684 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100819000212 | MT | Practitioner - Optometry | 8426182981 | Practice locations: Conrad, MT |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT345 | MT | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244678400000",
"number": "1871661355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 S DELAWARE ST",
"city": "CONRAD",
"state": "MT",
"postal_code": "594252310",
"telephone_number": "406-278-5331",
"fax_number": "406-278-7379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 S DELAWARE ST",
"city": "CONRAD",
"state": "MT",
"postal_code": "594252310",
"telephone_number": "406-278-5331",
"fax_number": "406-278-7379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "JOHN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2009-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MT",
"license": "MT345",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "048-9684",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conrad, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.