Individual provider Active NPI

Megan Roebuck Stanford, O.D.

  • Optometrist
  • San Antonio, TX
National Provider Identifier
1972951663
Registry record updated Jun 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8893T Issued in TX
Practice address
4096 N Foster Rd
San Antonio, TX 78244-1874
Phone
(210) 417-4707
NPI assigned
Jun 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8893T TX Primary

Addresses

Primary practice location

4096 N Foster Rd
San Antonio, TX 78244-1874

Mailing address

902 E Grayson St
San Antonio, TX 78208-1222
Phone (901) 647-0988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190522001384 MS Practitioner - Optometry 5597047886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

306 N Commerce St
Ripley, MS 38663-1721
Phone (662) 837-7822

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery63

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8893TXMDBehavioral Analyst
8893TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Vision Clinic LLC CurrentSince Apr 1, 2019 Accepting new patients
Stanford Dental Clinic, LLC PastSince Apr 1, 2019 Accepting new patients

Locations

306 N Commerce St
Ripley, MS 38663
Phone (662) 837-7822

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1972951663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 E GRAYSON ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782081222",
            "telephone_number": "901-647-0988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4096 N FOSTER RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782441874",
            "telephone_number": "210-417-4707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANFORD",
        "first_name": "MEGAN",
        "middle_name": "ROEBUCK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8893T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.