Jacob G Despain, O.D.
Individual provider Active NPI Optometrist · Cody, WY
NPI 1124284997 · NPPES record last updated Sep 27, 2013
Key facts
- NPI
- 1124284997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 327T (WY)
- Practice address
- 1708 Stampede Ave
Cody, WY 82414-4829 - Phone
- (307) 587-2404
- Fax
- (307) 527-7368
- NPI assigned
- Jul 31, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1708 Stampede Ave
Cody, WY 82414-4829
Phone (307) 587-2404
426 Nevada Ave
Lovell, WY 82431-1916
Phone (307) 548-7450
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 39 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130611000812 | WY | Practitioner - Optometry | 6406914266 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OD60035926 | WA | MD | Optometrist |
| 327T | WY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacob G. Despain OD PC | Optometrist | Current |
Accepting new patients |
| Jacob G. Despain OD PC | Optometrist | Current |
Accepting new patients |
| Richard D Jones Odpc | Optometrist | Past | Accepting new patients |
| Shopko Stores Operating Co. LLC | Past | Accepting new patients |
Locations
1708 Stampede Ave
Cody, WY 82414
Phone (307) 587-2404
426 Nevada Ave
Lovell, WY 82431
Phone (307) 548-7450
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OD60035926 | WA | |
| Optometrist | 152W00000X | 327T | WY | Yes |
Addresses
Primary practice location
1708 Stampede Ave
Cody, WY 82414-4829
Mailing address
1708 Stampede Ave
Cody, WY 82414-4829
Phone (307) 587-2404
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135237700 | Medicaid | WY | |
| W25396 | Other | WY | PTAN |
Other providers in Cody, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.