Individual provider Active NPI

J Dean Nolan, O.D.

  • Optometrist
  • Lawton, OK
National Provider Identifier
1558379669
Registry record updated Feb 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1091 Issued in OK
Practice address
3414 NW Cache Rd Ste E
Lawton, OK 73505-3877
Phone
(580) 353-2015
Fax
(580) 353-2022
NPI assigned
Aug 4, 2006
Last updated
Feb 17, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1091 OK Primary

Addresses

Primary practice location

3414 NW Cache Rd Ste E
Lawton, OK 73505-3877

Mailing address

3414 NW Cache Rd Ste E
Lawton, OK 73505-3877
Phone (580) 353-2015

Other identifiers 2

IdentifierTypeStateIssuer
100765020AMedicaidOK
1780858464OtherTYPE 2 ORGANIZATION NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20080923000518 OK Practitioner - Optometry 2163452483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3414 W Cache Rd
Suite E
Lawton, OK 73505-3877
Phone (580) 353-2015

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1091OKMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
J Dean Nolan OD Inc Optometrist CurrentSince Apr 30, 2003 Accepting new patients

Locations

3414 NW Cache Rd
Ste E
Lawton, OK 73505
Phone (580) 353-2015

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1558379669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3414 NW CACHE RD STE E",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735053877",
            "telephone_number": "580-353-2015",
            "fax_number": "580-353-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3414 NW CACHE RD STE E",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735053877",
            "telephone_number": "580-353-2015",
            "fax_number": "580-353-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "J DEAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "1091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100765020A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 2 ORGANIZATION NPI",
            "identifier": "1780858464",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.