Individual provider Active NPI

Robert Dewey Blase, OD

  • Optometrist
  • Wyoming, PA
National Provider Identifier
1477513612
Registry record updated Feb 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000804 Issued in PA
Practice address
155 Wyoming Ave
Wyoming, PA 18644-1708
Phone
(570) 693-1578
Fax
(570) 693-2010
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG000804 PA Primary

Addresses

Primary practice location

155 Wyoming Ave
Wyoming, PA 18644-1708

Mailing address

703 Rutter Ave
Kingston, PA 18704-4801
Phone (570) 288-7405

Other identifiers 1

IdentifierTypeStateIssuer
000901188MedicaidPA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101118000793 PA Practitioner - Optometry 3274729157 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vision Innovation Centers of Pennsylvania LLCGroup PAC ID 0840625349, 86 clinicians

Practice addresses (Care Compare)

170 Boston Ave
West Pittston, PA 18643-2724
Phone (570) 602-1010

Merit-based Incentive Payment System (MIPS)

Final score
85.08 of 100Reported as group
Quality
85.29
Promoting interoperability
100
Improvement activities
40
Cost
64.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG000804PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Innovation Centers of PA LLC Optometrist CurrentSince Jan 1, 2020 Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist CurrentSince Jan 1, 2020 Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist Current Accepting new patients
Vision Innovation Centers of Pennsylvania LLC Optometrist Past Accepting new patients

Locations

2661 Riva Rd
Ste 1030
Annapolis, MD 21401

40 Dallas Village Shopping Ctr
Dallas, PA 18612
Phone (570) 674-9001

703 Rutter Ave
Kingston, PA 18704
Phone (570) 288-7405

170 Boston Ave
West Pittston, PA 18643
Phone (570) 602-1010

Interoperability endpoints

  • Direct secure messaging: rblase@vip.emadirect.md

Organizations & group practices 4

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392940800000",
    "number": "1477513612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 RUTTER AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187044801",
            "telephone_number": "570-288-7405",
            "fax_number": "570-288-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 WYOMING AVE",
            "city": "WYOMING",
            "state": "PA",
            "postal_code": "186441708",
            "telephone_number": "570-693-1578",
            "fax_number": "570-693-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLASE",
        "first_name": "ROBERT",
        "middle_name": "DEWEY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2014-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000901188",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, PA

Sources for this page

Verify at the official NPI Registry.