NPIMap

Organization Active NPI

David J. Dexter, O.D., P.C.

  • Optometrist
  • Oswego, NY
National Provider Identifier
1205990157
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3632 Issued in NY
Legal business name
DAVID J. DEXTER, O.D., P.C.
Practice address
303 W Seneca St
Oswego, NY 13126-1831
Phone
(315) 343-2020
Fax
(315) 207-2001
NPI assigned
Dec 21, 2006
Last updated
Sep 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Dr. David Judson Dexter, O.D.NPI 1265524417
Title
Owner
Phone
(315) 343-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3632 NY Primary
Optometrist 152W00000X 6508 NY
Optometrist 152W00000X TUV007521-1 NY

Addresses

Primary practice location

303 W Seneca St
Oswego, NY 13126-1831

Mailing address

303 W Seneca St
Oswego, NY 13126-1831
Phone (315) 343-2020

Other identifiers 2

IdentifierTypeStateIssuer
DF6440OtherNYPALMETTO GBA-RR MC
02491014MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930014473 NY DME Supplier - Physician - Optometrist 5698894426 Practice locations: Oswego, NY
O20110415000568 NY Part B Supplier - Clinic/Group Practice 5698894426 Receives reassigned benefits from 9 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oswego, NY; Pulaski, NY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
David Dexter OD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

147 W 1st St
Oswego, NY 13126
Phone (315) 254-7600

303 W Seneca St
Oswego, NY 13126
Phone (315) 343-2020

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1205990157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 W SENECA ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131261831",
            "telephone_number": "315-343-2020",
            "fax_number": "315-207-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 W SENECA ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131261831",
            "telephone_number": "315-343-2020",
            "fax_number": "315-207-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID J. DEXTER, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "DEXTER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JUDSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-343-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "3632",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "6508",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007521-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA-RR MC",
            "identifier": "DF6440",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02491014",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oswego, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.