Thomas A Dettmer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

T03438 Issued in MO

Practice address

5962 Highway 54
Osage Beach, MO 65065-3338

Phone

(573) 552-8569

Fax

(573) 348-2747

NPI assigned

Sep 14, 2005

Last updated

Aug 17, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Illinois College of Optometry at Chicago, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paige Hedgpath OdpcGroup PAC ID 5991856460, 25 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: thomas.dettmer@direct.revolutionehr.com

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.

• Paige Hedgpath OD,PC

  dba Eyes On Missouri

  • Optometrist
  • Jefferson City, MO
  • NPI 1962644732
  Medicare reassignment Care Compare group NPD
• Paige Hedgpath Odpc

  dba Eyes On Missouri

  • Optometrist
  • Columbia, MO
  • NPI 1669530887
  NPD
• B &B Eyecare, LLC

  dba Family Eyecare Associates

  • Optometrist
  • Lake Ozark, MO
  • NPI 1255414918
  NPD (past)
• Lake Family Vision Center Inc

  dba Family Eyecare Associates

  • Optometrist
  • Laurie, MO
  • NPI 1720128713
  NPD (past)
• Wal-Mart Stores East, LP

  dba Walmart Pharmacy 10-2229

  • Pharmacy
  • Apollo Beach, FL
  • NPI 1437027208
  NPD (past)

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282003200000",
    "number": "1477548527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6436 RED BARN",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653069",
            "telephone_number": "573-552-8569",
            "fax_number": "573-348-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5962 HIGHWAY 54",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653338",
            "telephone_number": "573-552-8569",
            "fax_number": "573-348-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTMER",
        "first_name": "THOMAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2010-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T03438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "T03438",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasha B Conner, FNP
• Bradley D. Connett, M.D.
• Laura Davis, SLP
• Kim Ann Dempsey, PSY D
• John D Despain, M.D.
• James D Dexter, M.D.
• Dialysis Clinic Inc.
• Dialysis Clinic Inc. (DCI Lake Home Dialysis)
• Kasi Jamel Dibello, R.D., L.D.
• Deborah B Doll, LPC, CCTP, NCC

• Optometrist in Osage Beach, MO
• Providers in Osage Beach, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; 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.