Individual provider Active NPI

Teshawna Barker-Sutton, O.D.

  • Optometrist
  • London, KY
National Provider Identifier
1891796314
Registry record updated Dec 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1541DT Issued in KY
Practice address
930 E 4TH St
London, KY 40741-2521
Phone
(606) 878-7500
Fax
(606) 878-8005
NPI assigned
Aug 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1541DT KY Primary

Addresses

Primary practice location

930 E 4TH St
London, KY 40741-2521

Mailing address

103 Chera Lynn St
London, KY 40741-3142
Phone (606) 878-7500

Other identifiers 1

IdentifierTypeStateIssuer
77000834MedicaidKY

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
I20040630000682 KY Practitioner - Optometry 9436136272 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1541DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
20/20 Eyecare of London, LLC Optometrist CurrentSince Jul 15, 2008 Accepting new patients
Henry Matt Magee OD, PSC Optometrist Past Accepting new patients
Ulrich Medical Clinic, LLC Past Accepting new patients

Locations

103 Chera Lynn St
London, KY 40741
Phone (606) 878-7500

677 Meyers Baker Rd
London, KY 40741
Phone (606) 878-7500

930 E 4th St
London, KY 40741
Phone (606) 878-7500

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Health Express Family Practice and Urgent CareLondon, KY, CCN B03910 Rural health clinic 5% Or Greater Direct Ownership Interest (12.5%) May 6, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 and National Provider Directory roles.

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
20/20 Eyecare of London, LLC 3 clinicians

Practice addresses (Care Compare)

103 Chera Lynn St
London, KY 40741-3142

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery36

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514419200000",
    "number": "1891796314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CHERA LYNN ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407413142",
            "telephone_number": "606-878-7500",
            "fax_number": "606-878-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 E 4TH ST",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407412521",
            "telephone_number": "606-878-7500",
            "fax_number": "606-878-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARKER-SUTTON",
        "first_name": "TESHAWNA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2017-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1541DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77000834",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

Verify at the official NPI Registry.