NPIMap

Organization Active NPI

Embree Optometry PC

  • Optometrist
  • Fort Wayne, IN
National Provider Identifier
1982082855
Registry record updated May 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002923A Issued in IN
Legal business name
EMBREE OPTOMETRY PC
Practice address
1710 Apple Glen Blvd
Fort Wayne, IN 46804-1725
Phone
(260) 432-8908
Fax
(260) 432-8125
NPI assigned
May 12, 2015
Last updated
May 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2015

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

Authorized official

Name
Rodney C Embree
Title
Owner
Phone
(260) 432-8908

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002923A IN Primary

Addresses

Primary practice location

1710 Apple Glen Blvd
Fort Wayne, IN 46804-1725

Mailing address

1710 Apple Glen Blvd
Fort Wayne, IN 46804-1725

Other identifiers 1

IdentifierTypeStateIssuer
200953570MedicaidIN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1431388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431388800000",
    "number": "1982082855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 APPLE GLEN BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 APPLE GLEN BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041725",
            "telephone_number": "260-432-8908",
            "fax_number": "260-432-8125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBREE OPTOMETRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-12",
        "last_updated": "2015-05-12",
        "status": "A",
        "authorized_official_last_name": "EMBREE",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-432-8908"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002923A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200953570",
            "state": "IN"
        }
    ],
    "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 May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.