Individual provider Active NPI

Dallin Heiner, O.D.

  • Optometrist
  • Rexburg, ID
National Provider Identifier
1245346980
Registry record updated Sep 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP 100060 Issued in ID
Practice address
244 E Main St
Rexburg, ID 83440-2022
Phone
(208) 359-1880
Fax
(208) 359-2025
NPI assigned
Aug 23, 2006
Last updated
Sep 24, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP 100060 ID Primary

Addresses

Primary practice location

244 E Main St
Rexburg, ID 83440-2022

Mailing address

244 E Main St
Rexburg, ID 83440-2022
Phone (208) 359-1880

Other identifiers 4

IdentifierTypeStateIssuer
857241OtherIDDESERET MUTUAL
V6515OtherIDBLUE CROSS OF IDAHO
000010147628OtherIDREGENCE BLUE SHIELD OF ID
806951300MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20040923001224 ID Practitioner - Optometry 2062480676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Madison Clinic Optometry, P.C.Group PAC ID 8426026030, 2 clinicians

Practice addresses (Care Compare)

244 E Main St
Rexburg, ID 83440-2022
Phone (208) 359-1880

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP 100060IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Clinic Optometry, P.C. Optometrist CurrentSince Aug 1, 2004 Accepting new patients

Locations

244 E Main St
Rexburg, ID 83440
Phone (208) 359-1880

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222214400000",
    "number": "1245346980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402022",
            "telephone_number": "208-359-1880",
            "fax_number": "208-359-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402022",
            "telephone_number": "208-359-1880",
            "fax_number": "208-359-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINER",
        "first_name": "DALLIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP 100060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "857241",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "V6515",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010147628",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806951300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.