DR. KATIE SHULIST CONNOLLY (O.D.) – Optometrist, NPI 1164837506
Optometrist
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
1,126 OPTOMETRY in IN
Provider Addresses for DR. KATIE SHULIST CONNOLLY (O.D.)
744 E 3RD ST
BLOOMINGTON, IN 474053603
Phone: (812) 855-8436
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 13 Open Payments records for all available years, with a total value of $5,155.
Total Amount is formed as General ($5,155) + Research ($0) + Ownership ($0) = $5,155.
Last reported payment date: 2024-11-22 • Largest payer in this snapshot: CooperVision Inc. ($4,667).
Total Amount
$5,155
General + Research + Ownership
Payments
13
Total payment records
General Amount
$5,155
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-22
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CooperVision Inc. | $4,667 |
| Bausch & Lomb Americas Inc. | $112 |
| Mallinckrodt Hospital Products Inc. | $100 |
| LKC Technologies, Inc. | $96 |
| RxSight Inc | $96 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-08-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20140819001014 | I | Optometry | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 47405)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Dentist, Oral Surgery, Maxillofacial Surgery | IN | |
| Qualified Audiologist | IN | |
| O P T O M E T R Y | IN | |
| O P T O M E T R Y | IN | |
| O P T O M E T R Y | IN | |
| O P T O M E T R Y | IN | |
| - | IN | |
| O P T O M E T R Y | IN | |
| O P T O M E T R Y | IN | |
| Maxillofacial Surgery, Dentist, Oral Surgery, Anesthesiology | NC |
Reviews
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