Active NPI
Raymond Fada Jr., O.D.
- Optometrist
- Saint Peters, MO
National Provider Identifier
1013913094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T02848
- Practice address
- 6157 Mid Rivers Mall Dr
202
Saint Peters, MO 63304-1105 - Phone
- (636) 926-3647
- Fax
- (636) 926-3684
- NPI assigned
- Jun 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02848 | MO | Primary |
Addresses
Primary practice location
6157 Mid Rivers Mall Dr
202
Saint Peters, MO 63304-1105
Mailing address
40 E North St
Eureka, MO 63025-1205
Phone (636) 200-4393
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3180812005 | Medicaid | MO | |
| 410035943 | Other | MO | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clarkson Optometry Inc | Optometrist | Past | Accepting new patients |
Interoperability endpoints
- raymondfada@direct.eyecare-partners.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416268800000",
"number": "1013913094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 E NORTH ST",
"city": "EUREKA",
"state": "MO",
"postal_code": "630251205",
"telephone_number": "636-200-4393",
"fax_number": "636-938-2650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6157 MID RIVERS MALL DR",
"address_2": "202",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633041105",
"telephone_number": "636-926-3647",
"fax_number": "636-926-3684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FADA",
"first_name": "RAYMOND",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-23",
"last_updated": "2014-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T02848",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3180812005",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410035943",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
- Laurie J Evans-Schoenecker, LCSW
- James Glennon Evans, D.D.S.
- Joseph Charles Evola, DMD
- Evolution MD, LLC
- Executive Centre Surgical Services
- Romulo Joven Fajatin, MD
- Meredith Leigh Fallert, RD
- Zachary Patrick Fallon, M.D.
- Family Dental Services LTD
- Family Faith & Friends Home Health Care and Hospice Agency
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.