Active NPI
David J Dexter OD PC
- Optometrist
- Pulaski, NY
National Provider Identifier
1346377017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 003632
- Legal business name
- DAVID J DEXTER OD PC
- Practice address
- 3333 Maple Ave
Pulaski, NY 13142-2561 - Phone
- (315) 298-6966
- NPI assigned
- Feb 28, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. David J Dexter, OD
- Title
- President
- Phone
- (315) 298-6966
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 003632 | NY | Primary |
| Optometrist | 152W00000X | 006508 | NY |
Addresses
Primary practice location
3333 Maple Ave
Pulaski, NY 13142-2561
Mailing address
PO Box 196
Pulaski, NY 13142-0196
Phone (315) 298-6966
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02581597 | Medicaid | NY | |
| DF4300 | Other | NY | PALMETTO GBA-RAILROAD MC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930039550 | NY | DME Supplier - Physician - Optometrist | 5698894426 | Practice locations: Pulaski, NY |
| O20110415000568 | NY | Part B Supplier - Clinic/Group Practice | 5698894426 |
Receives reassigned benefits from 9 practitioners 2 other NPIs on this enrollment Practice locations: Oswego, NY; Pulaski, NY |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Harbor Eye Associates | Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- David Dexter OD PC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Oswego, NY
- NPI 1205990157
Locations
120 E 1st St
Ste 1
Oswego, NY 13126
Phone (315) 343-2020
Interoperability endpoints
- https://davidjdexterodpcwatertown.ef.prod.fhir.ema-api.com/fhir/r4/
- https://davidjdexterodpc.ef.prod.fhir.ema-api.com/fhir/r4/
Practitioners & affiliated clinicians
Practitioners 9
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1200960000000",
"number": "1346377017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 196",
"city": "PULASKI",
"state": "NY",
"postal_code": "131420196",
"telephone_number": "315-298-6966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 MAPLE AVE",
"city": "PULASKI",
"state": "NY",
"postal_code": "131422561",
"telephone_number": "315-298-6966"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DAVID J DEXTER OD PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-28",
"last_updated": "2008-01-22",
"status": "A",
"authorized_official_last_name": "DEXTER",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "315-298-6966",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "NY",
"license": "003632",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "NY",
"license": "006508",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02581597",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA-RAILROAD MC",
"identifier": "DF4300",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pulaski, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.