Daniel D Diedrich, O.D. – Optometrist in Marion, IN

Key facts

NPI: 1154380673
Entity type: Individual (NPI type 1)
Primary specialty: Optometrist 152W00000X
License: 18002338A (IN)
Practice address: 1400 N Baldwin Ave
Marion, IN 46952
Phone: (765) 664-6148
Fax: (765) 664-9782
NPI assigned: Mar 22, 2006
Sex: Male
Sole proprietor: No

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 and National Provider Directory roles.

Midwest Eye Consultants, P.C. Ophthalmology Physician · Fort Wayne, IN · NPI 1912960535

Medicare reassignment NPD IN
Midwest Eye Consultants, P.C. Optometrist · Noblesville, IN · NPI 1164485785

NPD OPTOMETRIST
Midwest Eye Consultants, P.C. Optometrist · Greensburg, IN · NPI 1013480482

NPD (past) OPTOMETRIST
Midwest Eye Consultants, P.C. Optometrist · Chesterton, IN · NPI 1023066784

NPD (past) OPTOMETRIST
Midwest Eye Consultants, P.C. Optometrist · Logansport, IN · NPI 1457314809

NPD (past) OPTOMETRIST

Medicare Care Compare profile

Merit-based Incentive Payment System (MIPS)

Final score: 55.99 of 100 (group)
Quality: 31.67
Improvement activities: 40
Cost: 78.58

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
18002338A	IN	MD	Optometrist

Practice roles

Organization	Specialty	Status	New patients
Midwest Eye Consultants, P.C.		Current	Accepting new patients
Midwest Eye Consultants, P.C.	Optometrist	Current since Jul 1, 2000	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
#2
Marion, IN 46952
Phone (765) 664-6148

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

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

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

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

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist	152W00000X	18002338A	IN	Yes

Addresses

Primary practice location

1400 N Baldwin Ave
Marion, IN 46952

Mailing address

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

Other identifiers

Identifier	Type	State	Issuer
1000094740	Medicaid	IN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 15, 2018.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000094740",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IN

All providers in Marion, IN · Optometrist in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2018. 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.

Verify at the official NPI Registry.