Individual provider Active NPI

John K Deaton, O.D.

  • Optometrist
  • Tyler, TX
National Provider Identifier
1497752109
Registry record updated Nov 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
05562TG Issued in TX
Practice address
1424 East Front
Tyler, TX 75702-8501
Phone
(903) 595-4144
Fax
(903) 596-7541
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 05562TG TX Primary

Addresses

Primary practice location

1424 East Front
Tyler, TX 75702-8501

Mailing address

PO Box 130639
Tyler, TX 75713-0639
Phone (903) 595-4167

Other identifiers 9

IdentifierTypeStateIssuer
70893OtherTXMEDICARE
047945301MedicaidTX
80154QOtherTXBLUE CROSS BLUE SHIELD
P02098771OtherTXMEDICARE RAIL ROAD
1964984OtherTXUNITED HEALTHCARE
21816989OtherTXFIRST HEALTH
7009226OtherTXAETNA
9942374OtherTXCIGNA
047945302MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20040721000097 TX Practitioner - Optometry 9830179936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

1424 E Front St
Christus Trinity Clinic
Tyler, TX 75702-8501
Phone (903) 595-4144

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

908 N Pacific St
Trinity Clinic
Mineola, TX 75773-1836
Phone (903) 569-9944

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05562TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Sep 1, 2018 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Sep 1, 2018 Accepting new patients

Locations

1705 Judson Rd
Longview, TX 75601
Phone (903) 758-4421

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

1424 E Front St
Tyler, TX 75702
Phone (903) 595-4167

Interoperability endpoints

  • Direct secure messaging: jdeaton171242@christushealth.direct-ci.net

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541462400000",
    "number": "1497752109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130639",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757130639",
            "telephone_number": "903-595-4167",
            "fax_number": "903-596-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 EAST FRONT",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028501",
            "telephone_number": "903-595-4144",
            "fax_number": "903-596-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEATON",
        "first_name": "JOHN",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2018-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "05562TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "70893",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047945301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "80154Q",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P02098771",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1964984",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "21816989",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7009226",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9942374",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047945302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.