Thomas A Dettmer, O.D.
Individual provider Active NPI Optometrist · Osage Beach, MO
NPI 1477548527 · NPPES record last updated Aug 17, 2010
Key facts
- NPI
- 1477548527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- T03438 (MO)
- Practice address
- 5962 Highway 54
Osage Beach, MO 65065-3338 - Phone
- (573) 552-8569
- Fax
- (573) 348-2747
- NPI assigned
- Sep 14, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Paige Hedgpath Odpc
Practice addresses (Care Compare)
1400 Forum Blvd
Suite 14
Columbia, MO 65203-1997
Phone (573) 446-0331
5962 Osage Beach Pkwy
Osage Beach, MO 65065-3338
Phone (573) 348-2747
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 62 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051201000075 | MO | Practitioner - Optometry | 8022038371 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paige Hedgpath Odpc | Optometrist | Current |
Accepting new patients |
| Paige Hedgpath OD,PC | Optometrist | Current |
Accepting new patients |
| B &B Eyecare, LLC | Optometrist | Past | Accepting new patients |
| Wal-Mart Stores East, LP | Past | Accepting new patients | |
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Lake Family Vision Center Inc | Optometrist | Past | Accepting new patients |
Locations
117 S Business Route 5
Camdenton, MO 65020
Phone (573) 346-5951
1400 Forum Blvd
Ste 14
Columbia, MO 65203
Phone (573) 446-0331
138 S Main St
Ste C
Gravois Mills, MO 65037
Phone (573) 374-5222
138 S Main St
Gravois Mills, MO 65037
Phone (573) 280-2884
323 Monroe St
Jefferson Cty, MO 65101
Phone (573) 635-1313
3251 Bagnell Dam Blvd
Ste D
Lake Ozark, MO 65049
Phone (573) 365-3717
5962 Osage Beach Pkwy
Osage Beach, MO 65065
Phone (573) 348-2747
Interoperability endpoints
- thomas.dettmer@direct.revolutionehr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T03438 | MO | Yes |
Addresses
Primary practice location
5962 Highway 54
Osage Beach, MO 65065-3338
Mailing address
6436 Red Barn
Osage Beach, MO 65065-3069
Phone (573) 552-8569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T03438 | Other | MO | LICENSE |
Other providers in Osage Beach, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.