Active NPI
Robert A Riddle, O.D.
- Optometrist
- Dexter, MO
National Provider Identifier
1093758146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T02532
- Practice address
- 203 W Stoddard St
Dexter, MO 63841-1654 - Phone
- (573) 624-7775
- Fax
- (573) 624-7775
- NPI assigned
- Jun 14, 2006
- Last updated
- Jan 12, 2012
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02532 | MO | Primary |
Addresses
Primary practice location
203 W Stoddard St
Dexter, MO 63841-1654
Mailing address
203 W Stoddard St
Dexter, MO 63841-1654
Phone (573) 624-7775
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 312329907 | Medicaid | MO | |
| 509168 | Other | MO | ADVANTRA FREEDOM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120229000097 | MO | Practitioner - Optometry | 7719095694 | Practice locations: Dexter, MO |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern California College of Optometry, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
203 W Stoddard St
Dexter, MO 63841-1654
Phone (573) 624-7775
Merit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 0
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 97 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326326400000",
"number": "1093758146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 W STODDARD ST",
"city": "DEXTER",
"state": "MO",
"postal_code": "638411654",
"telephone_number": "573-624-7775",
"fax_number": "573-624-7775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 W STODDARD ST",
"city": "DEXTER",
"state": "MO",
"postal_code": "638411654",
"telephone_number": "573-624-7775",
"fax_number": "573-624-7775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDDLE",
"first_name": "ROBERT",
"middle_name": "A",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2012-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T02532",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "312329907",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADVANTRA FREEDOM",
"identifier": "509168",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dexter, MO
- Nyssa Quatmann, MA, BCBA, LBA
- Dana Leigh Reeder, PSYD
- Edward D Reese, M.D.
- Rickman Speech and Language LLC
- Robin Rickman, M.A., CCC-SLP
- Brandi S Ritter, PLPC
- Daniel Melton Robinson, L.C.S.W., L.P.C.
- Ashley Irene Robison, PHARMD
- Caitlin Brooke Roe, FNP
- Saint Francis Medical Center (Saint Francis Clinic Dexter)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; 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.