Organization Active NPI

Dr. de Grasse & Associates, P.a.

  • Optometrist
  • Benbrook, TX
National Provider Identifier
1407078033
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TX5514 Issued in TX
Legal business name
DR. DE GRASSE & ASSOCIATES, P.A.
Practice address
105 Sproles Dr
Benbrook, TX 76126-3213
Phone
(817) 249-4078
Fax
(817) 249-4094
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Authorized official

Name
Dr. Jane De Grasse, O.D.NPI 1851372155
Title
Owner
Phone
(817) 346-2186

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TX5514 TX Primary

Addresses

Primary practice location

105 Sproles Dr
Benbrook, TX 76126-3213

Mailing address

105 Sproles Dr
Benbrook, TX 76126-3213
Phone (817) 249-4078

Other identifiers 1

IdentifierTypeStateIssuer
0007FFOtherTXBCBS GROUP #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050211000061 TX Part B Supplier - Clinic/Group Practice 5294787875 Receives reassigned benefits from 4 practitioners
Practice locations: Benbrook, TX

National Provider Directory

National Provider Directory

Locations

3811 S Cooper St
Ste 2004
Arlington, TX 76015
Phone (817) 468-4461

105 Sproles Dr
Benbrook, TX 76126
Phone (817) 249-4078

300 Mercedes St
Benbrook, TX 76126
Phone (817) 249-4078

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": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1407078033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SPROLES DR",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761263213",
            "telephone_number": "817-249-4078",
            "fax_number": "817-249-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SPROLES DR",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761263213",
            "telephone_number": "817-249-4078",
            "fax_number": "817-249-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. DE GRASSE & ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "DE GRASSE",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-346-2186",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "TX5514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "0007FF",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benbrook, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.

Verify at the official NPI Registry.