Individual provider Active NPI

Daniel D Diedrich, O.D.

  • Optometrist
  • Marion, IN
National Provider Identifier
1154380673
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002338A Issued in IN
Practice address
1400 N Baldwin Ave
Marion, IN 46952
Phone
(765) 664-6148
Fax
(765) 664-9782
NPI assigned
Mar 22, 2006
Last updated
Aug 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002338A IN Primary

Addresses

Primary practice location

1400 N Baldwin Ave
Marion, IN 46952

Mailing address

PO Box 168
Marion, IN 46952-0168
Phone (765) 664-6148

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20100301000087 IN Practitioner - Optometry 0244127504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
55.99 of 100Reported as group
Quality
31.67
Improvement activities
40
Cost
78.58

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Eye Consultants, P.C. Optometrist CurrentSince Jul 1, 2000 Accepting new patients
Midwest Eye Consultants, P.C. Current Accepting new patients
Midwest Eye Consultants, P.C. Optometrist Past Accepting new patients
Midwest Eye Consultants, P.C. Optometrist Past Accepting new patients
Midwest Eye Consultants, P.C. Optometrist Past Accepting new patients

Locations

301 J St
Laporte, IN 46350
Phone (219) 326-9569

326 Burlington Ave
Logansport, IN 46947
Phone (219) 753-3583

1400 N Baldwin Ave
Marion, IN 46952
Phone (765) 664-6148

1400 N Baldwin Ave
#2
Marion, IN 46952
Phone (765) 664-6148

3510 S Western Ave
Marion, IN 46953
Phone (765) 662-6594

935 W Main St
Peru, IN 46970
Phone (765) 472-4344

833 N Cass St
Wabash, IN 46992
Phone (260) 563-3672

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1154380673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 168",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469520168",
            "telephone_number": "765-664-6148",
            "fax_number": "765-664-9782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N BALDWIN AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "46952",
            "telephone_number": "765-664-6148",
            "fax_number": "765-664-9782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDRICH",
        "first_name": "DANIEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002338A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.