Optometrist Credentialing – A Guide to Getting Started

This is a sponsored post by Optometric Billing Consultants, a supporter of NewGradOptometry & new graduate optometrists! 😎

Now that you are new graduate of a school of optometry and have decided where you plan to begin practicing, it is time to make some important decisions that will insure you can start paying back those student loans or invest in your new practice.

Reimbursement today is dependent on which insurance plans you will accept. Time is of the essence and you need to start as soon as you have your license and location to practice.

Medical insurance plans are opportunities for optometric practices. Just take a look at the numbers for yourself. In 2015, the U.S. Census Bureau reported that 30 million residents or 9.1% of the population were uninsured. (The current US population is an estimated 325,000,000)

This means 295,425,000 or 90.9% are insured.

With this comes the headache of dealing with different rules, requirements and guidelines for each insurance payor.

Below you will some important steps along with an infographic, to help guide you in the right direction, to ensure you minimize the amount of road blocks you hit along the way.

Download the Infographic

Step 1: Setting up your business

The first step in becoming a provider for insurance companies like Medicare, Medicaid, Cigna, Aetna and many others is setting up your business.

Your first action in this process is deciding if your business will be a sole proprietorship or a corporation. It is recommended you consult a lawyer or accountant to ensure you make the right decision based on your situation. It is important to be consistent from the beginning to alleviate any headaches in the future.

You can learn more about the different business entities and tax implications in this video interview with Gary Topple, CPA.

Step 2: Apply/receive state license

The first step for starting the credentialing process is to apply for and receive your state professional license. Once you have been notified that your license has been approved be sure and print out a copy that can be sent with your credentialing applications.

Check out this guide on how to get your license in all 50 states, or these provinces for our Canadian audience.

Step 3: Apply/receive Individual NPI #

The second step is to apply for your individual NPI number.

When applying for your NPI number make sure that you are using your legal name as listed on your Social Security Card. You will have to list your Social Security number on your NPI application.

You will also have to have a practice location to link to on the NPI application. The website address for NPI is: https://nppes.cms.hhs.gov.

You will have to create a new account and then you can follow the steps for filling out the NPI application.

Check out this step by step guide on how to apply for an NPI number.

Step 4: Apply/receive Tax ID #

The next step is to decide how you want to set up your business.

After you have decided if you want to be a sole proprietor, an LLC, or a Corporation you can apply for the tax ID using whatever name you choose for your legal business name, and the type of business you will register as.

Once you have received the tax ID, you are now ready to set up the LLC or Corporation. You can register the LLC or Corporation on your Secretary of State website.

Step 5: If incorporating apply for Group NPI # after receiving Tax ID #

After receiving your tax ID letter from the IRS (letter 575 or 147C) you can go back to the NPPES web site and apply for your type II NPI number.

Please make sure that you list the business name exactly as the IRS letter lists it. Usually the IRS letter won’t list punctuation marks so be sure and don’t use punctuation marks on the NPI application.

After receiving your IRS letter it is also a good time to set up a checking account, listing your name on the checks exactly as on the IRS letter. Many insurance companies either encourage or request that they can make payments to you electronically, and it is important that all documents (IRS letter, NPI name and checking account) match exactly. This will speed up the process.

Be sure to check out this article with an overview on how to apply for credentialing with common vision care plans and medical insurance plans including Medicare!


Source: http://www.census.gov/
Source: http://www.census.gov/main/www/popclock.html

About Eric Botts O.D.

Eric Botts O.D.
Eric K. Botts has a Doctorate of Optometry from Southern College of Optometry, is a Third Party Trustee for Illinois Optometric Association, the President of the Energeyes Association, the Founder & Doctor of InnovativEyes Clinic, and the Founder & CEO of OBC Insurance Billing and Credentialing Specialists. Dr. Botts is a very passionate and engaging speaker with decades of real-world experience. He has hosted well over 250 Continuing Education Courses to 1,000s of fellow ODs! Besides having distinguished credentials Dr. Botts is a family man who has 3 daughters with his wife Lori, and they reside in the Midwest town of Macomb, IL.


  1. Shaina Sullivan

    I am a new associate at 2 different private practices and am working on credentialing with the companies each practice is in network with. Will I use each office’s Tax ID or do I use my SSN or apply for a Tax ID when applying to these companies?

    Thank you!

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