Debra Jean Nelissen, O.D.

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

OPT.0003292 Issued in CO

Practice address

Unit 33100
Apo, AE 09180-3100

Phone

(314) 590-8476

NPI assigned

Aug 7, 2006

Last updated

Sep 4, 2024By 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 3

Addresses

Other names 1

• Debra Jean McNamara Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

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.

• Rocky Mountain University Health Center

  • Optometrist
  • SLC, UT
  • NPI 1861141822
  NPD
• Rocky Mountain University of Health Professions Foundation

  • Physical Therapist
  • Provo, UT
  • NPI 1053174417

  Optometrist

  NPD

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1093724965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "UNIT 33100",
            "city": "APO",
            "state": "AE",
            "postal_code": "091803100",
            "telephone_number": "314-590-8476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "UNIT 33100",
            "city": "APO",
            "state": "AE",
            "postal_code": "091803100",
            "telephone_number": "314-590-8476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELISSEN",
        "first_name": "DEBRA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT.0003292",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "HI",
            "license": "OD-810",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "CO",
            "license": "OPT.0003292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "MCNAMARA",
            "middle_name": "JEAN",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.