Active NPI
Anthony Paul Dewilde, O.D.
- Optometrist
- Belton, MO
National Provider Identifier
1366637977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2007024168
- Practice address
- 101 Apple Valley Pkwy
Belton, MO 64012-4725 - Phone
- (816) 331-9590
- Fax
- (816) 331-9591
- NPI assigned
- Sep 7, 2007
- Last updated
- May 25, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2007024168 | MO | Primary |
Addresses
Primary practice location
101 Apple Valley Pkwy
Belton, MO 64012-4725
Mailing address
101 Apple Valley Pkwy
Belton, MO 64012-4725
Phone (816) 331-9590
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA2901 | Other | MO | PTAN |
| 1598067902 | Other | MO | MEDICARE GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Eyecare Zona Rosa Inc. | Optometrist | Past | Accepting new patients |
| Professional Eyecare Metro North Inc | Optometrist | Past | Accepting new patients |
Interoperability endpoints
- anthony.dewilde.1@16003.direct.athenahealth.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Kansas City, MO
- NPI 1568513836
-
- Optometrist
- Kansas City, MO
- NPI 1336291913
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306281600000",
"number": "1366637977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 APPLE VALLEY PKWY",
"city": "BELTON",
"state": "MO",
"postal_code": "640124725",
"telephone_number": "816-331-9590",
"fax_number": "816-331-9591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 APPLE VALLEY PKWY",
"city": "BELTON",
"state": "MO",
"postal_code": "640124725",
"telephone_number": "816-331-9590",
"fax_number": "816-331-9591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWILDE",
"first_name": "ANTHONY",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-07",
"last_updated": "2011-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "2007024168",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "MA2901",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "1598067902",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Belton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2011; 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.