Individual provider Active NPI

Damien R Delzer, OD

  • Optometrist
  • Fairbanks, AK
National Provider Identifier
1346228517
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT T 156 Issued in AK
Practice address
116 Minnie St
Fairbanks, AK 99701-3006
Phone
(907) 456-7760
Fax
(907) 451-7916
NPI assigned
Jan 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT T 156 AK Primary

Addresses

Primary practice location

116 Minnie St
Fairbanks, AK 99701-3006

Mailing address

116 Minnie St
Fairbanks, AK 99701-3006
Phone (907) 456-7760

Other identifiers 3

IdentifierTypeStateIssuer
A0330OtherAKBLUE CROSS
OD0156MedicaidAK
0194434OtherAKDEPT OF LABOR GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
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
I20101006001089 AK Practitioner - Optometry 6204028434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Clinic of Fairbanks IncGroup PAC ID 7719878370, 7 clinicians

Practice addresses (Care Compare)

116 Minnie St
Fairbanks, AK 99701-3006
Phone (907) 456-7760

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
14.17 of 100Reported as individual
Quality
28.35
Improvement activities
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
156AKMDChiropractor
OPT T 156AKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Clinic of Fairbanks, Inc Optometrist CurrentSince Aug 27, 1993 Accepting new patients

Locations

116 Minnie St
Fairbanks, AK 99701
Phone (907) 456-7760

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1346228517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MINNIE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013006",
            "telephone_number": "907-456-7760",
            "fax_number": "907-451-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 MINNIE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013006",
            "telephone_number": "907-456-7760",
            "fax_number": "907-451-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELZER",
        "first_name": "DAMIEN",
        "middle_name": "R",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AK",
            "license": "OPT T 156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "A0330",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OD0156",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR GROUP",
            "identifier": "0194434",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.