Kathryn A. Mayberry, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2009016930 Issued in MO

Practice address

812 N One Mile Rd
Dexter, MO 63841-1034

Phone

(573) 614-5393

Fax

(573) 614-5639

NPI assigned

Aug 20, 2008

Last updated

Sep 18, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kathryn A. Howard Former name

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dexter Family Eye Care, LLCGroup PAC ID 9436224888, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Dexter Family Eye Care, LLC

  • Clinic/Center
  • Dexter, MO
  • NPI 1962658971
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1124275235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411034",
            "telephone_number": "573-614-5393",
            "fax_number": "573-614-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411034",
            "telephone_number": "573-614-5393",
            "fax_number": "573-614-5639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "KATHRYN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2009016930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124275235",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MA1184",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "HOWARD",
            "middle_name": "A.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stacy Allen Mangum, PHARM.D.
• Marion Eye Centers, LTD.
• Marion Eye Centers, LTD.
• Alexis Mayberry, CCC-SLP
• Hillary A Mayberry, LPC
• Christa Renee McBroom, PHARMD
• Tonya McClain, PNP
• Angela Kaye McGowan, LPC
• Summer Lynn McGowan, LPC
• Amy Mekan, RN

• Optometrist in Dexter, MO
• Providers in Dexter, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.

Verify at the official NPI Registry.