Individual provider Active NPI

Douglas Bryant Pearson, O.D.

  • Optometrist
  • Pryor, OK
National Provider Identifier
1366440075
Registry record updated Apr 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1021 Issued in OK
Practice address
11 S Rowe St
Pryor, OK 74361-4626
Phone
(918) 825-6144
Fax
(918) 825-5374
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1021 OK Primary

Addresses

Primary practice location

11 S Rowe St
Pryor, OK 74361-4626

Mailing address

11 S Rowe St
Pryor, OK 74361-4626
Phone (918) 825-6144

Other identifiers 2

IdentifierTypeStateIssuer
731184882001OtherOKBLUECROSS BLUESHIELD
100761440AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20100726000494 OK Practitioner - Optometry 7315079498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11 S Rowe St
Pryor, OK 74361-4626
Phone (918) 825-6144

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas B Pearson Inc Optometrist CurrentSince May 21, 2010 Accepting new patients
Douglas B Pearson OD PastSince May 27, 2010 Accepting new patients

Locations

11 S Rowe St
Pryor, OK 74361
Phone (918) 825-6144

Organizations & group practices 2

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271635200000",
    "number": "1366440075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S ROWE ST",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743614626",
            "telephone_number": "918-825-6144",
            "fax_number": "918-825-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S ROWE ST",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743614626",
            "telephone_number": "918-825-6144",
            "fax_number": "918-825-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "DOUGLAS",
        "middle_name": "BRYANT",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2010-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "1021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "731184882001",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100761440A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pryor, OK

Sources for this page

Verify at the official NPI Registry.