Jason Kenneth Dickerson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

S-982-TA-567 Issued in AL

Practice address

2617 Highway 31 S
Pelham, AL 35124-1322

Phone

(205) 664-1575

Fax

(205) 664-1578

NPI assigned

Aug 19, 2005

Last updated

Jun 10, 2008By 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 5

Medicare fee-for-service enrollment

Enrolled in AL

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

University Alabama Birmingham - School of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pelham Eye Center LLCGroup PAC ID 4789094137, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pelham Eye Center LLC

  • Optometrist
  • Pelham, AL
  • NPI 1487252920
  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Alabama LLC

  dba MyEyeDr.

  • Optometrist
  • Tuscaloosa, AL
  • NPI 1770093551
  Medicare reassignment NPD
• Myeyedr Optometry of Alabama LLC

  dba MyEyeDr

  • Optometrist
  • Pelham, AL
  • NPI 1639644685
  NPD
• Myeyedr Optometry of Alabama, LLC

  dba MyEyeDr.

  • Optometrist
  • Cullman, AL
  • NPI 1104488055
  NPD
• Eye Health Partners of Alabama Inc

  • Optometrist
  • Birmingham, AL
  • NPI 1619923745
  NPD (past)

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1487646832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2617 HIGHWAY 31 S",
            "city": "PELHAM",
            "state": "AL",
            "postal_code": "351241322",
            "telephone_number": "205-664-1575",
            "fax_number": "205-664-1578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2617 HIGHWAY 31 S",
            "city": "PELHAM",
            "state": "AL",
            "postal_code": "351241322",
            "telephone_number": "205-664-1575",
            "fax_number": "205-664-1578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JASON",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-982-TA-567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSPRING",
            "identifier": "U86291",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "U86291",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIVA",
            "identifier": "U86291",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009933935",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51505633",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitney Talley Dean
• Laura Dennis
• Denton Dental of Pelham Dba Save-on
• Konstandena Sarris Desantis
• Diagnostic Health Corporation
• Keith Alan Dillard, D.M.D.
• Gena S Dismuke, M.S. CCC-SLP
• Divine Pediatrics, LLC
• Megan Leigh Siddens Doggett
• Julie Donachy, PT

• Optometrist in Pelham, AL
• Providers in Pelham, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.