Dick Whitaker, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

564 Issued in MS

Practice address

210 Serio Blvd
Ferriday, LA 71334-2015

Phone

(318) 757-3440

Fax

(318) 757-3446

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in LA

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

Specialty

Optometry

Education

Southern College of Optometry, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Milliken Eye Care, LLC

  dba Miss Lou Eye Care

  • Optometrist
  • Vidalia, LA
  • NPI 1952651523
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592352000000",
    "number": "1235212457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SERIO BLVD",
            "city": "FERRIDAY",
            "state": "LA",
            "postal_code": "713342015",
            "telephone_number": "318-757-3440",
            "fax_number": "318-757-3446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SERIO BLVD",
            "city": "FERRIDAY",
            "state": "LA",
            "postal_code": "713342015",
            "telephone_number": "318-757-3440",
            "fax_number": "318-757-3446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "DICK",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1060-169T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENET CHOICES HUMANA",
            "identifier": "721149589",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00087047",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PALMETTO",
            "identifier": "0133910002",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1388734",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "721149589",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF LA",
            "identifier": "2302B",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shanta Rena Wilson

• Optometrist in Ferriday, LA
• Providers in Ferriday, LA by specialty
• Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.