Active NPI
Gregory Eric Deatherage
- Optician
- Wichita Falls, TX
National Provider Identifier
1457544181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- Practice address
- 2916 Garnett Ave
Wichita Falls, TX 76308-1002 - Phone
- (940) 723-7241
- NPI assigned
- Aug 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | Primary |
Addresses
Primary practice location
2916 Garnett Ave
Wichita Falls, TX 76308-1002
Mailing address
2916 Garnett Ave
Wichita Falls, TX 76308-1002
Phone (940) 723-7241
Other names 1
- Mr. Gregory Eric Deatherage
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| T D Ventures Inc. | Optician | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216252800000",
"number": "1457544181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2916 GARNETT AVE",
"city": "WICHITA FALLS",
"state": "TX",
"postal_code": "763081002",
"telephone_number": "940-723-7241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2916 GARNETT AVE",
"city": "WICHITA FALLS",
"state": "TX",
"postal_code": "763081002",
"telephone_number": "940-723-7241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATHERAGE",
"first_name": "GREGORY",
"middle_name": "ERIC",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-27",
"last_updated": "2008-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "GREGORY",
"last_name": "DEATHERAGE",
"middle_name": "ERIC",
"prefix": "MR.",
"credential": "FNAO ABOC",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Wichita Falls, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.