Active NPI
Leland Carr, OD
- Optometrist
- Tahlequah, OK
National Provider Identifier
1891786778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1102
- Practice address
- 1001 N Grand Ave
Tahlequah, OK 74464-7017 - Phone
- (918) 458-2109
- Fax
- (918) 458-2310
- NPI assigned
- Oct 31, 2005
- 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 | 1102 | OK | Primary |
Addresses
Primary practice location
1001 N Grand Ave
Tahlequah, OK 74464-7017
Mailing address
1001 N Grand Ave
Tahlequah, OK 74464-7017
Phone (918) 456-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200081250A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1102 | OK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherokee Nation | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Tahlequah, OK
- NPI 1093722324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1891786778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 N GRAND AVE",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744647017",
"telephone_number": "918-456-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 N GRAND AVE",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744647017",
"telephone_number": "918-458-2109",
"fax_number": "918-458-2310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARR",
"first_name": "LELAND",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-31",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "1102",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200081250A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.