Lanny F Duclos, OD
Individual provider Active NPI Optometrist · Tooele, UT
NPI 1508827262 · NPPES record last updated Nov 1, 2007
Key facts
- NPI
- 1508827262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1138799934 (UT)
- Practice address
- 88 E 700 N
Ste a
Tooele, UT 84074-1817 - Phone
- (435) 882-6452
- Fax
- (435) 882-3170
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lanny F Duclos OD PC
Practice addresses (Care Compare)
88 E 700
Suite a
Tooele, UT 84074-1818
Phone (435) 882-6452
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- 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 |
|---|---|---|---|---|
| I20070126000001 | UT | Practitioner - Optometry | 0446251938 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1138799934 | UT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lanny F Duclos OD PC | Optometrist | Current |
Accepting new patients |
| Kris a Hill OD PC | Optometrist | Past |
Accepting new patients |
| Wendover Eye Care, Inc | Optometrist | Past |
Accepting new patients |
Locations
88 E 700 N
Ste A
Tooele, UT 84074
Phone (435) 882-5452
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1138799934 | UT | Yes |
Addresses
Primary practice location
88 E 700 N
Ste a
Tooele, UT 84074-1817
Mailing address
88 E 700 N
Ste a
Tooele, UT 84074-1817
Phone (435) 882-6452
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1804229 | Other | UT | WORKERS COMPENSATION |
| 39123 | Other | UT | PEHP |
| TPRA06734 | Medicaid | UT | |
| 10898 | Medicaid | UT | |
| PR07206 | Medicaid | UT | |
| QM0000016583 | Other | UT | ALTIUS |
| D1110 | Medicaid | UT |
Other providers in Tooele, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2007. 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.