Stanley M Dickerson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD612 Issued in TN

Practice address

840 Hatcher LN
Columbia, TN 38401-3528

Phone

(931) 381-4911

Fax

(931) 381-0966

NPI assigned

Jan 17, 2008

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

Medicare fee-for-service enrollment

Enrolled in TN

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

Interoperability endpoints

• Direct secure messaging: direct@dickersoneyecarecolumbiatn.compulinkdirect.com

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.

• Myeyedr Optometry of Tennessee, LLC

  • Optometrist
  • Chattanooga, TN
  • NPI 1619481587
  Medicare reassignment NPD
• Myeyedr Optometry of Tennessee, LLC

  • Optometrist
  • Mt Juliet, TN
  • NPI 1588516918
  NPD

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

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311724800000",
    "number": "1467638650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 HATCHER LN",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384013528",
            "telephone_number": "931-381-4911",
            "fax_number": "931-381-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 HATCHER LN",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384013528",
            "telephone_number": "931-381-4911",
            "fax_number": "931-381-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "STANLEY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-17",
        "last_updated": "2011-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Derryberry
• Kennedy Dewey-Mighell, LAT, ATC
• Varun Choudary Dhulipala, M.D.
• Dialysis Associates LLC
• Alyssa Dickerson, DO
• Timothy Clayton Dickey, FNP-C
• James Lewis Dickson, D.D.S.
• Danielle Diefenbach
• Amanda Colette Dierking
• Rochelle Denise Diestelkamp, CCC-SLP

• Optometrist in Columbia, TN
• Providers in Columbia, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; 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.