ETHAN T MENGLE (OD) – Optometrist, NPI 1417449174
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ETHAN T MENGLE (OD)
PO BOX 207170
DALLAS, TX 753207173
Phone: (636) 200-4393
Fax: (636) 527-0766
Type: Mailing
409 N COURT ST
MEDINA, OH 442561869
Phone: (330) 725-4680
Fax: (330) 633-7165
Type: Location
1155, Streetsboro Road, Streetsboro, Portage County, Ohio, 44241, United States
STREETSBORO, OH 442413969
Phone: (330) 422-2020
Fax: (330) 422-0316
Type: Location
1558 Akron Peninsula Rd
Akron, OH 443135154
Phone: (330) 922-4040
Type: Location
5697 Darrow Rd
Hudson, OH 442364013
Phone: (330) 650-0919
Type: Location
1155 State Route 303
Streetsboro, OH 442413969
Phone: (330) 422-2020
Fax: (330) 422-0316
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2018-06-15
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 |
|---|---|---|---|---|
| I20180615000251 | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 75320)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | TX | |
| - | OH | |
| - | OH |
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