Active NPI
David Dejesus, OPTICIAN
- Optician
- Port Clinton, OH
National Provider Identifier
1023718632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 6109SC
- Practice address
- 2826 E Harbor Rd
Port Clinton, OH 43452-2611 - Phone
- (419) 734-7995
- Fax
- (419) 734-7995
- NPI assigned
- Mar 3, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 6109SC | OH | Primary |
Addresses
Primary practice location
2826 E Harbor Rd
Port Clinton, OH 43452-2611
Mailing address
2826 E Harbor Rd
Port Clinton, OH 43452-2611
Phone (419) 734-7995
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6109SC | OH | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677801600000",
"number": "1023718632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2826 E HARBOR RD",
"city": "PORT CLINTON",
"state": "OH",
"postal_code": "434522611",
"telephone_number": "419-734-7995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2826 E HARBOR RD",
"city": "PORT CLINTON",
"state": "OH",
"postal_code": "434522611",
"telephone_number": "419-734-7995",
"fax_number": "419-734-7995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEJESUS",
"first_name": "DAVID",
"credential": "OPTICIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-03",
"last_updated": "2023-03-03",
"certification_date": "2023-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "OH",
"license": "6109SC",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Clinton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.