SHAWNEE VISION SOURCE
NPI 1104228105
Optometrist in Shawnee, OK
About Shawnee Vision Source NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHAWNEE VISION SOURCE (NPI 1104228105) is a healthcare organization registered as an optometrist in Shawnee, Oklahoma and active in the NPI registry since September 2014. The organization lists Trevor Conklin, Owner/partner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shawnee Vision Source is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Shawnee Vision Source, which bills Medicare for the services they deliver. Of these, 4 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (5)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Shawnee Eye Associates, PLLC's NPI number?
The NPI number for Shawnee Eye Associates, PLLC is 1104228105. It was assigned to this organization in the NPPES registry on September 22, 2014. The provider is doing business as Shawnee Vision Source.
Where is Shawnee Eye Associates, PLLC located?
Shawnee Eye Associates, PLLC is located at 100 E 45th St, Shawnee, OK 74804. The listed phone number is (405) 275-7676.
What is Shawnee Eye Associates, PLLC's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Shawnee Eye Associates, PLLC enrolled in Medicare?
Yes. Shawnee Eye Associates, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Shawnee Eye Associates, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians, all in Optometry, reassign their Medicare billing to Shawnee Eye Associates, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 4 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Shawnee Eye Associates, PLLC accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and BlueCross BlueShield of Tennessee list Shawnee Eye Associates, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Shawnee Eye Associates, PLLC was last updated on September 22, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Shawnee Vision Source · NPI 1104228105
Optometrist organization in Shawnee, Oklahoma. Organization record, active in the CMS NPPES registry since September 22, 2014.
## Identity
- **NPI:** 1104228105 (Entity type: Organization)
- **Enumerated:** September 22, 2014
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Legal business name:** Shawnee Eye Associates, Pllc
- **Organization subpart:** No
- **Authorized official:** Trevor Conklin, OWNER/PARTNER
## Practice location
- **Address:** 100 E 45TH ST, Shawnee, OK 74804-1439
- **Phone:** (405) 275-7676 · **Fax:** (405) 275-6837
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 5 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R); 4 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 22, 2014
- **Other identifiers:** Medicaid 200350320A (OK)
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Source: [NPI Profile](https://npiprofile.com/npi/1104228105) · Data from the CMS NPPES public registry.