Zachary Blake Dirks, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3080 Issued in MN

Practice address

320 Sunrise Dr
Saint Peter, MN 56082-1352

Phone

(507) 931-6436

Fax

(504) 934-9625

NPI assigned

Jul 11, 2007

Last updated

Feb 29, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Optometry

Education

Southern California College of Optometry, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Le Sueur Eyecare Center LLCGroup PAC ID 9032586193, 3 clinicians

Belle Plaine Eyecare Center LLCGroup PAC ID 6305169830, 2 clinicians

St. Peter Eyecare CenterGroup PAC ID 2466487871, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Belle Plaine Eyecare Center LLC

  • Optometrist
  • Belle Plaine, MN
  • NPI 1730582735
  Medicare reassignment Care Compare group NPD Authorized official
• Le Sueur Eyecare Center LLC

  dba Le Sueur Eyecare Center

  • Optometrist
  • Le Sueur, MN
  • NPI 1932268257
  Medicare reassignment Care Compare group NPD Authorized official
• St. Peter Eyecare Center

  • Optometrist
  • Saint Peter, MN
  • NPI 1134274475
  Medicare reassignment Care Compare group NPD
• St Peter Eyecare Center, Inc

  • Optometrist
  • Le Center, MN
  • NPI 1972657658
  NPD (past)

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204243200000",
    "number": "1366640377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 SUNRISE DR",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560821352",
            "telephone_number": "507-931-6436",
            "fax_number": "504-934-9625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 SUNRISE DR",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560821352",
            "telephone_number": "507-931-6436",
            "fax_number": "504-934-9625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRKS",
        "first_name": "ZACHARY",
        "middle_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-11",
        "last_updated": "2008-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS EYEWEAR/CARE",
            "identifier": "44977TH",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA MEDICAID",
            "identifier": "1366640377",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1366640377",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "139494",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "076N5DI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP82001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1051614",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0322460001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA EYEWEAR/CARE",
            "identifier": "2116066",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Devetter, DO
• Michelle Marie Dick, LICSW
• Lauren Renaye Lefavor Dickie, PSYD LP
• Direct Care and Treatment - Forensic Services
• Blake Thomas Dirks, OD
• Makenna Douglas, PSY.D., LP
• Julie K Drier, MD
• Ashley Dungan, DPT
• Matthew James Eberhardt, MS, ATC, ATR, CSCS
• Breckan Nicholas Ebnet

• Optometrist in Saint Peter, MN
• Providers in Saint Peter, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; 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.
• 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.

Verify at the official NPI Registry.