Doris Ann Els, OD
Individual provider Active NPI Optometrist · Salem, IL
NPI 1174583587 · NPPES record last updated Nov 25, 2008
Key facts
- NPI
- 1174583587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- T02362 (MO)
- Practice address
- 121 N Broadway
Salem, IL 62881-1509 - Phone
- (618) 548-4866
- Fax
- (618) 548-4867
- NPI assigned
- Mar 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1978
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
121 N Broadway
Salem, IL 62881-1509
Phone (618) 548-4866
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- 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 |
|---|---|---|---|---|
| I20080118000746 | IL | Practitioner - Optometry | 1951482645 | Practice locations: Salem, IL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 346.000261 | IL | MD | Optometrist |
| MO0213619 | IL | MD | Optometrist |
| T02362 | MO | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046007117 | IL | |
| Optometrist | 152W00000X | T02362 | MO | Yes |
| Optometrist | 152W00000X | 346.000261 | IL | |
| Optometrist | 152W00000X | MO0213619 | IL |
Addresses
Primary practice location
121 N Broadway
Salem, IL 62881-1509
Mailing address
121 N Broadway
Salem, IL 62881-1509
Phone (618) 548-4866
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 215959 | Other | IL | MEDICARE PTAN |
| P00084010 | Other | IL | RAILROAD MEDICARE PTAN |
| IL7117 | Other | IL | EYEMED |
Other names
- Dr. Doris Ann Osborne
Other providers in Salem, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2008. 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.