Active NPI
Desoto Eyecare Inc
- Exclusive Provider Organization
- Southaven, MS
National Provider Identifier
1376576884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exclusive Provider Organization
- License
- 14992
- Legal business name
- DESOTO EYECARE INC
- Practice address
- 726 Goodman Rd E Ste B
Southaven, MS 38671-9530 - Phone
- (662) 349-1959
- Fax
- (662) 349-0424
- NPI assigned
- Jul 8, 2006
- Organization subpart
- Yes
- Parent organization
- DESOTO EYECARE INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Alan R Schaeffer, M.D.
- Title
- MD Owner
- Phone
- (662) 349-1959
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exclusive Provider Organization | 302F00000X | 14992 | MS | Primary |
Addresses
Primary practice location
726 Goodman Rd E Ste B
Southaven, MS 38671-9530
Mailing address
726 Goodman Rd E Ste B
Southaven, MS 38671-9530
Phone (662) 349-1959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS, TN
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080721000259 | MS | Part B Supplier - Clinic/Group Practice | 1254232655 |
Receives reassigned benefits from 5 practitioners Practice locations: Olive Branch, MS; Southaven, MS |
| O20090630000612 | TN | Part B Supplier - Clinic/Group Practice | 1254232655 |
Receives reassigned benefits from 4 practitioners Practice locations: Jackson, TN; Memphis, TN |
National Provider Directory
National Provider Directory- Part of
- Desoto Eyecare Inc
Locations
7164 Hacks Cross Rd
Ste 126
Olive Branch, MS 38654
Phone (662) 895-3937
775 Goodman Rd E
Ste 1
Southaven, MS 38671
Phone (662) 349-0424
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1348012800000",
"number": "1376576884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "726 GOODMAN RD E STE B",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719530",
"telephone_number": "662-349-1959",
"fax_number": "662-349-0424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "726 GOODMAN RD E STE B",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719530",
"telephone_number": "662-349-1959",
"fax_number": "662-349-0424"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DESOTO EYECARE INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DESOTO EYECARE INC",
"enumeration_date": "2006-07-08",
"last_updated": "2012-09-19",
"status": "A",
"authorized_official_last_name": "SCHAEFFER",
"authorized_official_first_name": "ALAN",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "MD OWNER",
"authorized_official_telephone_number": "662-349-1959",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "302F00000X",
"taxonomy_group": "",
"desc": "Exclusive Provider Organization",
"state": "MS",
"license": "14992",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.