Rebecca Ann Deruyter, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

02253 Issued in IA

Practice address

1111 Holton Dr
Le Mars, IA 51031-2884

Phone

(712) 546-6868

Fax

(712) 546-6739

NPI assigned

Sep 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Eye Health

  • Optometrist
  • Le Mars, IA
  • NPI 1922319888
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083716070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 HOLTON DR",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312884",
            "telephone_number": "712-546-6868",
            "fax_number": "712-546-6739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 HOLTON DR",
            "city": "LE MARS",
            "state": "IA",
            "postal_code": "510312884",
            "telephone_number": "712-546-6868",
            "fax_number": "712-546-6739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUYTER",
        "first_name": "REBECCA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacie Daily, LMHC
• Jessica Davis, RN
• Tyler James Dejong, T-LMHC
• Tracy May Delao, T-CADC
• Lindsey Denouden, RN
• Kelley Dickey Cuddy, LMHC
• Daryl Erwin Doorenbos, M.D.
• Hannah Marie Dreckman
• Kayley Diane Dresback, OTR/L, MOT
• Adam David Erdmann, D.D.S.

• Optometrist in Le Mars, IA
• Providers in Le Mars, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.