DR. JACQUELYN GAYLE SHORT (O.D.) – Optometrist, NPI 1588072003
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
700 OPTOMETRY in KY
Provider Addresses for DR. JACQUELYN GAYLE SHORT (O.D.)
467 SUNSET TRL
JELLICO, TN 377622709
Phone: (423) 784-2020
Fax: (423) 784-4940
Type: Mailing
207 MAIN ST
WILLIAMSBURG, KY 407691121
Phone: (606) 549-0464
Type: Location
467 Sunset Trl
Jellico, TN 377622709
Phone: (423) 784-2020
Fax: (423) 784-4940
Type: Location
395 Forest Cir Unit 120
Jonesborough, TN 376591439
Phone: (423) 753-7760
Type: Location
207 Main St
Williamsburg, KY 407691121
Phone: (606) 549-0464
Type: Location
PO BOX 38
ARCHBOLD, OH 435020038
Phone: (419) 445-5436
Fax: (419) 446-4818
Type: Mailing
1001 S DEFIANCE ST
ARCHBOLD, OH 435021617
Phone: (419) 445-5436
Fax: (419) 446-4818
Type: Location
800 N Clinton St Ste D
Defiance, OH 435124611
Phone: (419) 782-1901
Fax: (419) 782-2200
Type: Location
800 N CLINTON ST
STE D
DEFIANCE, OH 435124611
Phone: (419) 782-1901
Type: Mailing
7600 KINGSTON PIKE STE 1480
KNOXVILLE, TN 379195632
Phone: (865) 694-7527
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $46.
Total Amount is formed as General ($46) + Research ($0) + Ownership ($0) = $46.
Last reported payment date: 2024-11-06 • Largest payer in this snapshot: Alcon Vision LLC ($30).
Total Amount
$46
General + Research + Ownership
Payments
3
Total payment records
General Amount
$46
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Alcon Vision LLC | $30 |
| Bausch & Lomb Americas Inc. | $15 |
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: 2021-10-07
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 |
|---|---|---|---|---|
| I20211007002972 | I | Optometry | OH | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 92014 | Established patient complete exam of visual system | 124 | 123 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 96 | 61 | $0 |
| 92134 | Imaging of retina | 74 | 49 | $0 |
| 92133 | Imaging of optic nerve | 62 | 49 | $0 |
| 92083 | Exam of visual field with extended testing | 33 | 29 | $0 |
Insurance plans in this area (ZIP 37762)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OH | |
| - | OH | |
| O P T O M E T R Y | OH |
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