Active NPI
Chadron Vision Center, Inc.
- Optometrist
- Gordon, NE
National Provider Identifier
1972533354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- CHADRON VISION CENTER, INC.
- Practice address
- 112 N Main St
Gordon, NE 69343-1524 - Phone
- (308) 282-0820
- Fax
- (308) 282-0833
- NPI assigned
- Jul 3, 2006
- Last updated
- Jul 6, 2011
- Organization subpart
- Yes
- Parent organization
- CHADRON VISION CENTER INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Joseph L. Shetler, O.D.
- Title
- Owner / Optometrist
- Phone
- (308) 282-0820
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | NU | Primary |
Addresses
Primary practice location
112 N Main St
Gordon, NE 69343-1524
Mailing address
112 N Main St
Gordon, NE 69343-1524
Phone (308) 282-0820
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 508922022 | Medicaid | NE | |
| 9200330 | Medicaid | SD | |
| 507303268 | Medicaid | NE | |
| 507800115 | Medicaid | NE | |
| 504082854 | Medicaid | NE | |
| 9200912 | Medicaid | SD | |
| 9202142 | Medicaid | SD | |
| 9203682 | Medicaid | SD |
Other names 1
- Gordon Vision Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050317001024 | NE | Part B Supplier - Clinic/Group Practice | 8123073574 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chadron, NE; Gordon, NE |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Chadron Vision Center Inc
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Optometrist
- Chadron, NE
- NPI 1245226984
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Optometrist
- Gordon, NE
- NPI 1952362139
-
- Optometrist
- Chadron, NE
- NPI 1417916321
-
- Optometrist
- Pine Ridge, SD
- NPI 1538268388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1309910400000",
"number": "1972533354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 N MAIN ST",
"city": "GORDON",
"state": "NE",
"postal_code": "693431524",
"telephone_number": "308-282-0820",
"fax_number": "308-282-0833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 N MAIN ST",
"city": "GORDON",
"state": "NE",
"postal_code": "693431524",
"telephone_number": "308-282-0820",
"fax_number": "308-282-0833"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHADRON VISION CENTER, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CHADRON VISION CENTER INC",
"enumeration_date": "2006-07-03",
"last_updated": "2011-07-06",
"status": "A",
"authorized_official_last_name": "SHETLER",
"authorized_official_first_name": "JOSEPH",
"authorized_official_middle_name": "L.",
"authorized_official_title_or_position": "OWNER / OPTOMETRIST",
"authorized_official_telephone_number": "308-282-0820",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "508922022",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9200330",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "507303268",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "507800115",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "504082854",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9200912",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9202142",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9203682",
"state": "SD"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Gordon Vision Center",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Gordon, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.