Paul R Dewitt, OD – Optometrist in Teecnospos, AZ

Key facts

NPI: 1366474207
Entity type: Individual (NPI type 1)
Primary specialty: Optometrist 152W00000X
License: 2320 (CO)
Practice address: US Hwy 160 & Navajo Route 35 - Red Mesa
Teecnospos, AZ 86514
Phone: (928) 656-5000
NPI assigned: Jul 7, 2006
Sex: Male
Sole proprietor: No

Organizations & group practices 5

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.

Kayenta Alternative Rural Hospital General Acute Care Hospital · Kayenta, AZ · NPI 1174692529

Medicare reassignment NPD TX
DHHS, PHS, Naihs, Shiprock Hospital General Acute Care Hospital · Shiprock, NM · NPI 1780639971

Medicare reassignment NPD TX
DHHS, PHS, Naihs, Shiprock Hospital General Acute Care Hospital · Teecnospos, AZ · NPI 1477615789

NPD
DHHS PHS Naihs Shiprock Hospital Durable Medical Equipment & Medical Supplies · Teecnospos, AZ · NPI 1215083951

NPD (past)
Kayenta Alternative Rural Hospital General Acute Care Hospital · Tonalea, AZ · NPI 1740359108

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TX
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20040618001214	TX	Practitioner - Optometry	2567447170	Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
2320	CO	MD	Physician Assistant

Practice roles

Organization	Status	New patients
DHHS, PHS, Naihs, Shiprock Hospital	Current	Accepting new patients
Kayenta Alternative Rural Hospital	Current since Feb 3, 2015	Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital	Current since Dec 2, 2019	Accepting new patients
DHHS PHS Naihs Shiprock Hospital	Past since Dec 9, 2019	Accepting new patients
Kayenta Alternative Rural Hospital	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist	152W00000X	2320	CO	Yes

Addresses

Primary practice location

US Hwy 160 & Navajo Route 35 - Red Mesa
Teecnospos, AZ 86514

Mailing address

HC 61 Box 30
Teec Nos Pos, AZ 86514-9600
Phone (928) 656-5000

Other identifiers

Identifier	Type	State	Issuer
796063	Medicaid	AZ
65837533	Medicaid	NM

Other providers in Teecnospos, AZ

All providers in Teecnospos, AZ · Optometrist in Arizona

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.