Gary Lee Dietterick, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG000606 Issued in PA

Practice address

21 Corporate Dr
Ste.#2
Easton, PA 18045-2664

Phone

(610) 258-2442

Fax

(610) 258-7965

NPI assigned

Jan 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in PA

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

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 and National Provider Directory roles.

• Ja Vision Enterprises

  • Optometrist
  • Easton, PA
  • NPI 1336743632
  Medicare reassignment NPD

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1407836851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CORPORATE DR",
            "address_2": "STE.#2",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180452664",
            "telephone_number": "610-258-2442",
            "fax_number": "610-258-7965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CORPORATE DR",
            "address_2": "STE.#2",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180452664",
            "telephone_number": "610-258-2442",
            "fax_number": "610-258-7965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETTERICK",
        "first_name": "GARY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA#",
            "identifier": "3803518",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RR MEDICARE",
            "identifier": "P00227588",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BC",
            "identifier": "01776201",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "624066",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "180026868",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devendra K Amin MD, PC
• Arjun Dhillon, DO
• Raven Gwendolyn Diacou, MD, PHD
• Diane W. Miller, MSW, LCSW, LLC
• Anthony Joseph Dicesare, DO
• Karen M. Dietterick, R.N.
• William J Digiacomo, DPT
• Alan Van Dilsaver, DDS
• Douglas D Ditmars
• Allison Dobias

• Optometrist in Easton, PA
• Providers in Easton, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.