Angela Marie Dedionisio, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4383AT Issued in OR

Practice address

38 Rossanley Dr
Medford, OR 97501

Phone

(561) 275-2020

NPI assigned

Jun 28, 2015

Last updated

Aug 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Optometry

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care Group of Southern Oregon LLCGroup PAC ID 4082629290, 3 clinicians

Lake Oswego Vision Clinic LLCGroup PAC ID 8628052362, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eye Care Group of Southern Oregon, LLC

  dba Eye Care Group

  • Optometrist
  • Grants Pass, OR
  • NPI 1306988787
  Medicare reassignment Care Compare group NPD
• Lake Oswego Vision Clinic LLC

  dba Lake Oswego Vision Clinic

  • Optometrist
  • Lake Oswego, OR
  • NPI 1750506937
  Medicare reassignment Care Compare group NPD
• Daniel & Max LLC

  dba Stanton Optical

  • Eyewear Supplier
  • Medford, OR
  • NPI 1922594159

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1435449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1417339359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 ROSSANLEY DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 ROSSANLEY DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97501",
            "telephone_number": "561-275-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDIONISIO",
        "first_name": "ANGELA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-28",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003059",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "4383AT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Lynn Deal, LMT
• Mia N Deane, LMT
• Yin Deascentis
• Lindy Sue Deatherage, M.D.
• Giovanna A Debortoli
• Shawnna Dedrick
• Andrew Scott Defrance, LMFT
• Kyla Defranco, COTA/L
• Degrazia Wellness, LLC
• Christa Elane Degrazia, NP

• Optometrist in Medford, OR
• Providers in Medford, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; 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.