Sue Ellen Van Dootingh, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3643 Issued in OH

Practice address

820 Jefferson St
Port Clinton, OH 43452-2416

Phone

(419) 732-2828

NPI assigned

Nov 27, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Madison Eye Care of Port Clinton LLC

  • Optometrist
  • Port Clinton, OH
  • NPI 1427748243
  Medicare reassignment NPD

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248912000000",
    "number": "1366518045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 JEFFERSON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434522416",
            "telephone_number": "419-732-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 JEFFERSON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434522416",
            "telephone_number": "419-732-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DOOTINGH",
        "first_name": "SUE",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2009-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0629387",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie Twarek, R.N.
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• Mary Ellen Vallance
• Taylor Anne Vanness
• Peggy Vaughn
• Barbara A Vonthron, NP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP

• Optometrist in Port Clinton, OH
• Providers in Port Clinton, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.