NPIMap

Organization Active NPI

Eyecare Professionals, Inc

  • Optometrist
  • Nevada, MO
National Provider Identifier
1891820122
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 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
Last updated
Dec 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2007

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

Authorized official

Name
Delton L Fast, ODNPI 1770618084
Title
Pres of Corp
Phone
(417) 667-3076

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2051630Eyecare Professionals Inc111 North Main Street, Nevada, MO 64772Certificate of waiverDec 20, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eyecare Professionals Inc111 N Main St, Nevada, MO 64772-2330(417) 667-3076 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Sep 30, 2004

National Provider Directory

National Provider Directory

Locations

111 N Main St
Nevada, MO 64772
Phone (417) 667-3076

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1891820122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MAIN ST",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647722330",
            "telephone_number": "417-667-3076",
            "fax_number": "417-667-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MAIN ST",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647722330",
            "telephone_number": "417-667-3076",
            "fax_number": "417-667-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE PROFESSIONALS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "FAST",
        "authorized_official_first_name": "DELTON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRES OF CORP",
        "authorized_official_telephone_number": "417-667-3076",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nevada, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.