Individual provider Active NPI

Daryl W. Hodges, O.D.

  • Optometrist
  • Greencastle, IN
National Provider Identifier
1235119074
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001787B Issued in IN
Practice address
814 E Washington St
Greencastle, IN 46135-1850
Phone
(765) 653-5896
Fax
(765) 653-4554
NPI assigned
Jan 18, 2006
Last updated
Mar 17, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18001787B IN Primary

Addresses

Primary practice location

814 E Washington St
Greencastle, IN 46135-1850

Mailing address

814 E Washington St
Greencastle, IN 46135-1850
Phone (765) 653-5896

Other identifiers 1

IdentifierTypeStateIssuer
100210920AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110927000195 IN Practitioner - Optometry 0840306510 Practice locations: Greencastle, IN

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18001787BINMDOptometrist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1235119074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 E WASHINGTON ST",
            "city": "GREENCASTLE",
            "state": "IN",
            "postal_code": "461351850",
            "telephone_number": "765-653-5896",
            "fax_number": "765-653-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 E WASHINGTON ST",
            "city": "GREENCASTLE",
            "state": "IN",
            "postal_code": "461351850",
            "telephone_number": "765-653-5896",
            "fax_number": "765-653-4554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGES",
        "first_name": "DARYL",
        "middle_name": "W.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001787B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100210920A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greencastle, IN

Sources for this page

Verify at the official NPI Registry.