Active NPI
Dennis R Mirra, O. D.
- Optometrist
- Dover, DE
National Provider Identifier
1295720522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- I3-0001149
- Practice address
- 885 S Governors Ave
Dover, DE 19904-4158 - Phone
- (302) 734-5861
- Fax
- (302) 734-1921
- NPI assigned
- Sep 13, 2005
- Sex
- Male
- Sole proprietor
- No
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 | I3-0001149 | DE | Primary |
Addresses
Primary practice location
885 S Governors Ave
Dover, DE 19904-4158
Mailing address
885 S Governors Ave
Dover, DE 19904-4158
Phone (302) 734-5861
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000302622 | Medicaid | DE | |
| 510292224 | Other | DE | UNITED HEALTHCARE |
| P01245272 | Other | DE | PALMETTO GBA RR MEDICARE PTAN GROUP 1245251313 |
| 4405500 | Other | DE | AETNA |
| 1603 | Other | DE | COVENTRY |
| B86041 | Other | DE | DE BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391126400000",
"number": "1295720522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "885 S GOVERNORS AVE",
"city": "DOVER",
"state": "DE",
"postal_code": "199044158",
"telephone_number": "302-734-5861",
"fax_number": "302-734-1921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "885 S GOVERNORS AVE",
"city": "DOVER",
"state": "DE",
"postal_code": "199044158",
"telephone_number": "302-734-5861",
"fax_number": "302-734-1921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRRA",
"first_name": "DENNIS",
"middle_name": "R",
"credential": "O. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-13",
"last_updated": "2014-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "DE",
"license": "I3-0001149",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000302622",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "510292224",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA RR MEDICARE PTAN GROUP 1245251313",
"identifier": "P01245272",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4405500",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "1603",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DE BLUE CROSS",
"identifier": "B86041",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dover, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.