Individual provider Active NPI

Dale A Potter, O.D.

  • Optometrist
  • Decatur, AL
National Provider Identifier
1245218767
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S456TA074 Issued in AL
Practice address
2349 Danville Rd SW
Suite 410
Decatur, AL 35603-4284
Phone
(256) 353-2392
Fax
(256) 353-8489
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X S456TA074 AL Primary

Addresses

Primary practice location

2349 Danville Rd SW
Suite 410
Decatur, AL 35603-4284

Mailing address

2349 Danville Rd SW
Suite 410
Decatur, AL 35603-4284
Phone (256) 353-2392

Other identifiers 2

IdentifierTypeStateIssuer
000058307MedicaidAL
051044598OtherALBLUECROSSBLUESHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20050915001189 AL Practitioner - Optometry 4789617002 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyecare Associates, Inc.Group PAC ID 0749254001, 52 clinicians

Practice addresses (Care Compare)

2349 Danville Rd SW
Suite 410
Decatur, AL 35603-4285
Phone (256) 353-2392

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecare Associates, Inc. Optometrist Current Accepting new patients
Eyecare Associates, Inc. Optometrist CurrentSince Aug 26, 1994 Accepting new patients
Eyecare Associates, Inc. Optometrist CurrentSince Mar 26, 2019 Accepting new patients
Eyecare Associates, Inc. Past Accepting new patients

Locations

2349 Danville Rd SW
Ste 410
Decatur, AL 35603
Phone (256) 353-2392

7880 Old Madison Pike
Madison, AL 35758
Phone (256) 772-8711

Interoperability endpoints

  • Direct secure messaging: dalepotter@direct.eyecare-partners.com
  • Direct secure messaging: dapotter@direct.revolutionehr.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1245218767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2349 DANVILLE RD SW",
            "address_2": "SUITE 410",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356034284",
            "telephone_number": "256-353-2392",
            "fax_number": "256-353-8489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2349 DANVILLE RD SW",
            "address_2": "SUITE 410",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356034284",
            "telephone_number": "256-353-2392",
            "fax_number": "256-353-8489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTER",
        "first_name": "DALE",
        "middle_name": "A",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S456TA074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000058307",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "051044598",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

Verify at the official NPI Registry.