Individual provider Active NPI

Darrell A. Rousse, O.D.

  • Optometrist
  • Wright Patterson AFB, OH
National Provider Identifier
1124091467
Registry record updated Apr 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5527 Issued in OH
Practice address
2510 5TH St BLDG 840
Wright Patterson AFB, OH 45433-7951
Phone
(937) 938-2681
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2826 WI
Optometrist 152W00000X 5527 OH Primary

Addresses

Primary practice location

2510 5TH St BLDG 840
Wright Patterson AFB, OH 45433-7951

Mailing address

2510 5TH St BLDG 840
Wright Patterson AFB, OH 45433-7951
Phone (937) 938-2681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20200508001715 OH Order and Referring Only - OptometryPractitioner - Optometry 5597196485

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2826WIMDOptometrist
5527OHMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522886400000",
    "number": "1124091467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 5TH ST BLDG 840",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454337951",
            "telephone_number": "937-938-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 5TH ST BLDG 840",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454337951",
            "telephone_number": "937-938-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSE",
        "first_name": "DARRELL",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2018-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2826",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wright Patterson AFB, OH

Sources for this page

Verify at the official NPI Registry.