Great Plains Vision Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

2647 Issued in OK

Legal business name

GREAT PLAINS VISION CENTER

Practice address

1418 Main St
Woodward, OK 73801-3004

Phone

(580) 256-6699

Fax

(580) 256-6706

NPI assigned

May 11, 2011

Organization subpart

No

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

Authorized official

Name

Jacoby J Dewald, ODNPI 1740591973

Title

Optometrist / Owner

Phone

(580) 256-6699

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Jacoby John Dewald, OD

  • Optometrist
  • Woodward, OK
  • NPI 1740591973
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348185600000",
    "number": "1194017020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2484",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738022484",
            "telephone_number": "580-256-6699",
            "fax_number": "580-256-6706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 MAIN ST",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738013004",
            "telephone_number": "580-256-6699",
            "fax_number": "580-256-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT PLAINS VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2012-09-21",
        "status": "A",
        "authorized_official_last_name": "DEWALD",
        "authorized_official_first_name": "JACOBY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST / OWNER",
        "authorized_official_telephone_number": "580-256-6699",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Woodward, OK
• Providers in Woodward, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (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.