Individual provider Active NPI

Deval I Desai, OD

  • Optometrist
  • Winston Salem, NC
National Provider Identifier
1336344282
Registry record updated Dec 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2059 Issued in NC
Practice address
3320 Silas Creek Pkwy
300
Winston Salem, NC 27103-3031
Phone
(336) 760-2169
Fax
(336) 760-2385
NPI assigned
Jun 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4570 MA
Optometrist 152W00000X 2059 NC Primary

Addresses

Primary practice location

3320 Silas Creek Pkwy
300
Winston Salem, NC 27103-3031

Mailing address

954 Berryhill LN
Winston Salem, NC 27106-9831
Phone (336) 923-8260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20090316000366 NC Practitioner - Optometry 8123185378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

261 Cooper Creek Dr
Mocksville, NC 27028-5967
Phone (336) 751-2890

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4570MAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Deval I Desai OD PLLC Optometrist CurrentSince Jan 1, 2016 Accepting new patients
Eyecarecenter OD PA Optometrist Past Accepting new patients
Luxottica of America Inc Past Accepting new patients
Fox Eye Care Group Optometrist PastSince May 1, 1991 Accepting new patients

Locations

160 Lowes Blvd
Lexington, NC 27292
Phone (336) 243-5661

261 Cooper Creek Dr
Mocksville, NC 27028
Phone (336) 751-1340

Organizations & group practices 4

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": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292371200000",
    "number": "1336344282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "954 BERRYHILL LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271069831",
            "telephone_number": "336-923-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 SILAS CREEK PKWY",
            "address_2": "300",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033031",
            "telephone_number": "336-760-2169",
            "fax_number": "336-760-2385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESAI",
        "first_name": "DEVAL",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2010-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4570",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.