NPIMap

Organization Active NPI

Massie Optometry PC

  • Optometrist
  • Saint Louis, MO
National Provider Identifier
1255675740
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2002005316 Issued in MO
Legal business name
MASSIE OPTOMETRY PC
Practice address
465 N New Ballas Rd
Saint Louis, MO 63141-6824
Phone
(314) 878-1377
Fax
(314) 878-1384
NPI assigned
Nov 21, 2012
Organization subpart
Yes
Parent organization
PERFORMANCE EYECAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Authorized official

Name
Dr. Dirk F Massie, ODNPI 1972510345
Title
President
Phone
(618) 234-3053

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 2002005316 MO Primary

Addresses

Primary practice location

465 N New Ballas Rd
Saint Louis, MO 63141-6824

Mailing address

4111 N Illinois St
Swansea, IL 62226-7609
Phone (618) 234-3053

Other names 1

  • PERFORMANCE EYECARE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130523000656 MO Part B Supplier - Clinic/Group Practice 0840438222 Receives reassigned benefits from 6 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory
Part of
Performance Eyecare PC

Locations

465 N New Ballas Rd
Saint Louis, MO 63141
Phone (314) 626-4020

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1353456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1255675740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 N ILLINOIS ST",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622267609",
            "telephone_number": "618-234-3053",
            "fax_number": "618-234-6331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 N NEW BALLAS RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416824",
            "telephone_number": "314-878-1377",
            "fax_number": "314-878-1384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSIE OPTOMETRY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PERFORMANCE EYECARE",
        "enumeration_date": "2012-11-21",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "MASSIE",
        "authorized_official_first_name": "DIRK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-234-3053",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2002005316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PERFORMANCE EYECARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PERFORMANCE EYECARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; 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.