NPIMap

Organization Active NPI

Retina Associates, PSC

  • Optician
  • Louisville, KY
National Provider Identifier
1952454142
Registry record updated Jan 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
RETINA ASSOCIATES, PSC
Practice address
1536 Story Ave
Louisville, KY 40206-1738
Phone
(502) 589-1500
Fax
(502) 589-1556
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2012

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

Authorized official

Name
Mr. Mark M Prussian, CEO
Title
Administrator
Phone
(502) 589-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 156FX1800X Primary

Addresses

Primary practice location

1536 Story Ave
Louisville, KY 40206-1738

Mailing address

1536 Story Ave
Louisville, KY 40206-1738
Phone (502) 589-1500

Other identifiers 2

IdentifierTypeStateIssuer
100221560MedicaidIN
65917502MedicaidKY

Other names 1

  • The Eye Care Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930017282 KY DME Supplier - Physician - Optometrist 5991602757 1 other NPI on this enrollment
Practice locations: Louisville, KY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
18D2069729Eye Care Institute, the1536 Story Avenue, Louisville, KY 40206Certificate of waiverDec 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Eye Care Institute3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326844800000",
    "number": "1952454142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 STORY AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061738",
            "telephone_number": "502-589-1500",
            "fax_number": "502-589-1556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 STORY AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061738",
            "telephone_number": "502-589-1500",
            "fax_number": "502-589-1556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA ASSOCIATES, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2012-01-18",
        "status": "A",
        "authorized_official_last_name": "PRUSSIAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "502-589-1500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100221560",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65917502",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Eye Care Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; 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.