Dallas Dustin Fitzgerald, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

T03343 Issued in MO

Practice address

1605 S Main St
Wal-Mart Vision Center
Maryville, MO 64468-2611

Phone

(660) 562-0215

Fax

(660) 562-0217

NPI assigned

Jan 27, 2006

Sex

Male

Sole proprietor

Yes

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.

• Eyecare Centers of America

  • Eyewear Supplier
  • San Antonio, TX
  • NPI 1164633665

  Optometrist

  NPD (past)

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare fee-for-service enrollment

Enrolled in MO

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.

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 28, 2008.

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211932800000",
    "number": "1396716619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19738 SUNSET RDG",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645058560",
            "telephone_number": "816-662-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 S MAIN ST",
            "address_2": "WAL-MART VISION CENTER",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682611",
            "telephone_number": "660-562-0215",
            "fax_number": "660-562-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "DALLAS",
        "middle_name": "DUSTIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2008-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T03343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396716619",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "050599111",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "313842429",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE WEST",
            "identifier": "050599111",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "25269097",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeff Farnan
• Terra R Feick, PLPC
• John Michael Feuerbacher, M.D.
• Charles S Fillingane II, DO
• Lisa Finney, FNP-C
• Miranda Marie Floyd, AGACNP
• Jack L Forest, D.O.
• Joshua Wayne Foster, DO
• Fox Ridge Wellness & Rehabilitation LLC
• David A Fox II, M.D.

• All providers in Maryville, MO
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.