Active NPI
Diane C Dewitt, O.D.
- Optometrist
- Clovis, NM
National Provider Identifier
1265412639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2364
- Practice address
- 1217 Pile St
Clovis, NM 88101-5944 - Phone
- (575) 763-5522
- Fax
- (575) 763-4722
- NPI assigned
- Jan 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2364 | NM | Primary |
Addresses
Primary practice location
1217 Pile St
Clovis, NM 88101-5944
Mailing address
PO Box 700
Clovis, NM 88102-0700
Phone (575) 763-5522
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P1167 | Medicaid | NM | |
| NM00P427 | Other | NM | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100322000505 | NM | Practitioner - Optometry | 0143362608 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of Houston - College of Optometry, 1987
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Clovis Vision Associates PA
Practice addresses (Care Compare)
1217 Pile St
Clovis, NM 88101-5944
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 26 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2364 | NM | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clovis Vision Associates PA | Optometrist | Current | Accepting new patients |
Locations
1217 Pile St
Clovis, NM 88101
Phone (505) 763-5522
Interoperability endpoints
- drdewitt@clovisvision.eyefinity-direct.com
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308096000000",
"number": "1265412639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 700",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881020700",
"telephone_number": "575-763-5522",
"fax_number": "575-763-4722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 PILE ST",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881015944",
"telephone_number": "575-763-5522",
"fax_number": "575-763-4722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWITT",
"first_name": "DIANE",
"middle_name": "C",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-20",
"last_updated": "2011-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NM",
"license": "2364",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P1167",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "NM00P427",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; 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.