NPIMap

Organization Active NPI

Dietrich Opticians, PA

  • Durable Medical Equipment & Medical Supplies
  • Manasquan, NJ
National Provider Identifier
1376727347
Registry record updated Dec 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
31TD00185200 Issued in NJ
Legal business name
DIETRICH OPTICIANS, PA
Practice address
134 Main St
Manasquan, NJ 08736-3558
Phone
(732) 223-2020
NPI assigned
Dec 26, 2007
Last updated
Dec 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2007

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

Authorized official

Name
Peter Allen Goetz, OPTICIANNPI 1780708099
Title
Owner
Phone
(732) 223-2020

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 31TD00185200 NJ Primary

Addresses

Primary practice location

134 Main St
Manasquan, NJ 08736-3558

Mailing address

134 Main St
Manasquan, NJ 08736-3558
Phone (732) 223-2020

Other identifiers 1

IdentifierTypeStateIssuer
7425406MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930059351 NJ DME Supplier - Optician 8224157409 Practice locations: Manasquan, NJ

National Provider Directory

National Provider Directory

Locations

134 Main St
Manasquan, NJ 08736
Phone (732) 223-2020

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198627200000",
    "number": "1376727347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 MAIN ST",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087363558",
            "telephone_number": "732-223-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 MAIN ST",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087363558",
            "telephone_number": "732-223-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIETRICH OPTICIANS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2007-12-26",
        "status": "A",
        "authorized_official_last_name": "GOETZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-223-2020",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NJ",
            "license": "31TD00185200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7425406",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manasquan, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; 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.

Verify at the official NPI Registry.