Tara Leanne Dew, O.D.
Individual provider Active NPI Optometrist · Kosciusko, MS
NPI 1265622971 · NPPES record last updated Jan 22, 2008
Key facts
- NPI
- 1265622971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 776 (MS)
- Practice address
- 59 Veterans Memorial Dr
Ste. B
Kosciusko, MS 39090-3433 - Phone
- (662) 289-1067
- NPI assigned
- Jul 29, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Angela M Thomas OD Inc
Practice addresses (Care Compare)
59 Veterans Memorial Dr
Suite B
Kosciusko, MS 39090-3430
Phone (662) 289-1067
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 30 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080110000201 | MS | Practitioner - Optometry | 3678653094 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Angela M Thomas, O.D., Inc. | Optometrist | Current |
Accepting new patients |
| Kevin Kosek Eye Clinic, P.a. | Past |
Accepting new patients |
Locations
59 Veterans Memorial Dr
Kosciusko, MS 39090
Phone (662) 289-1067
59 Veterans Memorial Dr
Ste B
Kosciusko, MS 39090
Phone (662) 289-1067
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 776 | MS | Yes |
Addresses
Primary practice location
59 Veterans Memorial Dr
Ste. B
Kosciusko, MS 39090-3433
Mailing address
PO Box 778
Kosciusko, MS 39090-0778
Phone (662) 289-1067
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04501384 | Medicaid | MS |
Other providers in Kosciusko, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.