NPIMap

Organization Active NPI

University Park Vision Center LLC

  • Optometrist
  • Fort Wayne, IN
National Provider Identifier
1932861713
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
UNIVERSITY PARK VISION CENTER LLC
Practice address
1221 Medical Park Dr
Fort Wayne, IN 46825-5887
Phone
(260) 471-2000
Fax
(260) 471-2100
NPI assigned
Oct 9, 2021
Last updated
Nov 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Authorized official

Name
Dr. Amy Reidhaar, ODNPI 1609283258
Title
Optometrist
Phone
(260) 471-2000

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU
Optometrist 152W00000X NU Primary
Corneal and Contact Management Optometrist 152WC0802X NU
Pediatric Optometrist 152WP0200X NU

Addresses

Primary practice location

1221 Medical Park Dr
Fort Wayne, IN 46825-5887

Mailing address

10723 Knollton Run
Fort Wayne, IN 46818-8746
Phone (260) 705-2285

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211123002267 IN Part B Supplier - Clinic/Group Practice 5294125787 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Wayne, IN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1633737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637625600000",
    "number": "1932861713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10723 KNOLLTON RUN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468188746",
            "telephone_number": "260-705-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 MEDICAL PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255887",
            "telephone_number": "260-471-2000",
            "fax_number": "260-471-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PARK VISION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-09",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A",
        "authorized_official_last_name": "REIDHAAR",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "260-471-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.