DSM Optometry LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100185 Issued in ID

Legal business name

DSM OPTOMETRY LLC

Practice address

2300 E 17TH St
Idaho Falls, ID 83404-6504

Phone

(208) 525-8964

Fax

(208) 524-6562

NPI assigned

Jun 16, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Damon Scott Mortensen, OD

Title

Owner/Dr.

Phone

(208) 525-8964

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kreyton Dirk Jackson, O.D.

  • Optometrist
  • Ontario, OR
  • NPI 1982915203
  NPD (past)

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1154616258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 MILL STREAM ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405385",
            "telephone_number": "208-821-0016",
            "fax_number": "208-524-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046504",
            "telephone_number": "208-525-8964",
            "fax_number": "208-524-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DSM OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "DAMON",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER/DR.",
        "authorized_official_telephone_number": "208-525-8964",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1760619365",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808388100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Garl Drake, D.M.D.
• Trevor Lee Drake, CRNA, MHS
• Dreamworks Anesthesia PC
• Aaron Scott Drees, CRNA, DNAP, RN
• James G Drewett, PHARM.D., PH.D.
• Kenneth D Dudley, LPC
• Beth Duenes
• Heather Page Duffey, CNM
• McKenzie Leigh Duncan, LPC
• Victoria J Duncan, DC

• All providers in Idaho Falls, ID
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; 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.