Eyecare Professionals, Inc
Organization Active NPI Optometrist · Nevada, MO
NPI 1891820122 · NPPES record last updated Dec 11, 2007
Key facts
- NPI
- 1891820122
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- EYECARE PROFESSIONALS, INC
- Practice address
- 111 N Main St
Nevada, MO 64772-2330 - Phone
- (417) 667-3076
- Fax
- (417) 667-8690
- NPI assigned
- Feb 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Delton L Fast, OD
- Title
- Pres of Corp
- Phone
- (417) 667-3076
Practitioners 5
-
Delton L Fast, OD
-
Jeremy M. Fast, O.D.
-
Melvin Jerome Clark, M.D.
-
Joseph J. Parelman, M.D.
-
Steven R Unterman, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2051630 | Eyecare Professionals Inc | Certificate of waiver | Dec 20, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Eyecare Professionals Inc |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040921001087 | MO | Part B Supplier - Clinic/Group Practice | 5193793776 |
Receives reassigned benefits from 2 practitioners Practice locations: Nevada, MO |
| O20100930059054 | MO | DME Supplier - Physician - Optometrist | 5193793776 | Practice locations: Nevada, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
111 N Main St
Nevada, MO 64772-2330
Mailing address
111 N Main St
Nevada, MO 64772-2330
Phone (417) 667-3076
Other providers in Nevada, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.