EXECUTIVE PARK EYE CARE, PLLC
NPI 1528156734
Optometrist in Colorado Springs, CO
NPI Status: Active since October 11, 2006
Contact Information
9240 EXPLORER DR STE 100
COLORADO SPRINGS, CO
ZIP 80920
Phone: (719) 574-7000
Fax: (719) 597-1712
- Organization
- Optometrist
- Accepts Insurance
- Medicare Supplier
- Accepts Medicare Approved Payment
- CLIA Number: 06D2101311
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-30-2025
About EXECUTIVE PARK EYE CARE, PLLC
This page provides the complete NPI Profile along with additional information for Executive Park Eye Care, Pllc, a provider established in Colorado Springs, Colorado operating as a Optometrist. The healthcare provider is registered in the NPI registry with number 1528156734 assigned on October 2006. The practitioner's primary taxonomy code is 152W00000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's former legal business name is Executive Park Eye Care, Llc. The authorized official of this NPI record is Dr. Jeanne R Derber O.d. (Owner/optometrist)
- NPI
- 1528156734
- Provider Legal Name
- EXECUTIVE PARK EYE CARE, PLLC
- Other Organization Name
- EXECUTIVE PARK EYE CARE, LLC
- Other Name Type
- Former Legal Business Name (4)
- Entity Type
- Organization
- Location Address
- 9240 EXPLORER DR STE 100 COLORADO SPRINGS, CO 80920
- Location Phone
- (719) 574-7000
- Location Fax
- (719) 597-1712
- Mailing Address
- 9240 EXPLORER DR STE 100 COLORADO SPRINGS, CO 80920
- Mailing Phone
- (719) 574-7000
- Mailing Fax
- (719) 597-1712
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-11-2006
- Last Update Date
- 11-02-2021
- Code Navigator
Executive Park Eye Care, Pllc is a medicare supplier with PTAN 20634215 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Prosthetic Lenses: Conventional Eyeglasses or Prosthetic Lenses: Conventional Contact Lenses.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Optometrist
- Taxonomy Code
- 152W00000X
- Type
- Eye and Vision Services Providers
- Taxonomy Description
- Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BlueCross B07S HSA - EPO
- BlueCross B15S $0 virtual care from Teladoc Health � - EPO
- BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � - EPO
- BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � - EPO
- BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � - EPO
- BlueCross S25S $55 PCP Copay + $0 virtual care from Teladoc Health � - EPO
- BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � - EPO
- BlueCross S27S $60 PCP Copay + $0 virtual care from Teladoc Health � - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 27239721 | MEDICAID (05) | CO |
Medical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20634215
- Accepts Medicare Assignment
- YES
- Specialities List
- Optometrist.
- Competitive Bidding
- NO
Supplies List
- Prosthetic Lenses: Conventional Eyeglasses - Conventional Eyeglasses
- Prosthetic Lenses: Conventional Contact Lenses - Conventional Contact Lenses
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 06D2101311
- Facility Type
- Physician Office
- Certificate Effective Date
- August 31, 2023
- Certificate Expiration Date
- August 30, 2025
- Laboratory Director
- CURTIS W. GALES
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Executive Park Eye Care, Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 5 | 2 | 8 | 1 | 5 | 6 | 7 | 3 | 4 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 4 | 8 | 2 | 5 | 12 | 7 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 4 + 8 + 2 + 5 + 1 + 2 + 7 + 6 + 24 = 66 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 66 = 4 | 4 | ||||||||
The NPI number 1528156734 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1013976224 | JEANNE RUTH DERBER O.D. Individual | Optometrist | 9240 EXPLORER DR STE 100 COLORADO SPRINGS, CO 80920 (719) 574-7000 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1528156734, enumerated in the NPI registry as an "organization" on October 11, 2006
The provider is located at 9240 Explorer Dr Ste 100 Colorado Springs, Co 80920 and the phone number is (719) 574-7000
This medical organization specializes in Optometrist with taxonomy code 152W00000X
The provider might be accepting Accepts: BlueCross BlueShield of Tennessee, Medicare and. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 06D2101311 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on October 11, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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