Individual provider Active NPI

Teri K. Whittaker I, OD

  • Optometrist
  • Bryant, AR
National Provider Identifier
1982615977
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2573 Issued in AR
Practice address
2900 Horizon Dr Ste 15
Bryant, AR 72022-9095
Phone
(504) 653-2020
Fax
(501) 653-7407
NPI assigned
Aug 11, 2006
Last updated
Jun 25, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2573 AR Primary

Addresses

Primary practice location

2900 Horizon Dr Ste 15
Bryant, AR 72022-9095

Mailing address

11225 Huron LN Ste 200a
Little Rock, AR 72211-1861
Phone (501) 653-2020

Other identifiers 1

IdentifierTypeStateIssuer
163095722MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20070118000303 AR Practitioner - Optometry 2769483718 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr. Shane F Laster PAGroup PAC ID 9234499120, 5 clinicians

Practice addresses (Care Compare)

1435 W Ctr St
Suite a
Greenwood, AR 72936-3414
Phone (479) 888-1515

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2573ARMDDental Hygienist

Practice roles

OrganizationSpecialtyStatusNew patients
Bryant Eyecare Clinic Optometrist CurrentSince May 18, 2020 Accepting new patients
Dr. Shane F. Laster P.a. Optometrist CurrentSince Jun 1, 2025 Accepting new patients
Iiii Optical - the Valley LLC PastSince Mar 1, 2021 Accepting new patients

Locations

2 Riviera Dr
Booneville, AR 72927
Phone (479) 675-3451

2900 Horizon Dr
Ste 15
Bryant, AR 72022
Phone (501) 653-2020

8500 S 36th Ter
Fort Smith, AR 72908
Phone (479) 242-2020

1435 W Center St
Ste A
Greenwood, AR 72936
Phone (479) 888-1515

11225 Huron Ln
Ste 200A
Little Rock, AR 72211

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1982615977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11225 HURON LN STE 200A",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722111861",
            "telephone_number": "501-653-2020",
            "fax_number": "501-653-7407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 HORIZON DR STE 15",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720229095",
            "telephone_number": "504-653-2020",
            "fax_number": "501-653-7407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITTAKER",
        "first_name": "TERI",
        "middle_name": "K.",
        "name_suffix": "I",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163095722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryant, AR

Sources for this page

Verify at the official NPI Registry.