Elizabeth Ann Dannebrock, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV007844-1 Issued in NY

Practice address

500 Davison Rd
Lockport, NY 14094-4021

Phone

(716) 434-8063

Fax

(716) 434-2845

NPI assigned

Jun 25, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Elizabeth Ann Hetrick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: elizabeth.hetrick@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Davison Road Optical Inc

  • Eyewear Supplier
  • Newfane, NY
  • NPI 1669599247
  NPD (past)

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567987200000",
    "number": "1134483191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 DAVISON RD",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140944021",
            "telephone_number": "716-434-8063",
            "fax_number": "716-434-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 DAVISON RD",
            "city": "LOCKPORT",
            "state": "NY",
            "postal_code": "140944021",
            "telephone_number": "716-434-8063",
            "fax_number": "716-434-2845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANNEBROCK",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-25",
        "last_updated": "2019-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007844-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "HETRICK",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Crystal Springs Medical PC
• Mary Jo Currie
• Chelsea Ann Dagostino
• Dale Association
• Patricia J Danaher, M.D.
• Lisa Anne Dannebrock
• David P. Nichols, M.D., P.C.
• Davison Road Optical Inc
• Davison Road Optical, Inc.
• Juan De Rosas, MD

• Optometrist in Lockport, NY
• Providers in Lockport, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.