Individual provider Active NPI

Jacob Heath, O.D.

  • Optometrist
  • Dexter, MO
National Provider Identifier
1558714840
Registry record updated Apr 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2016023867 Issued in MO
Practice address
1207 N One Mile Rd
Dexter, MO 63841-1041
Phone
(573) 624-4584
Fax
(573) 624-4992
NPI assigned
Jul 21, 2016
Last updated
Apr 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2016023867 MO Primary

Addresses

Primary practice location

1207 N One Mile Rd
Dexter, MO 63841-1041

Mailing address

1200 W Deyoung St
Marion, IL 62959-4437
Phone (618) 993-5686

Other practice location 1

117 N Main St
Charleston, MO 63834-1674
Phone (573) 683-2020

Other practice location 2

212 S Main St
Sikeston, MO 63801-3034
Phone (573) 572-8181

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160805000515 MO Practitioner - Optometry 1456645910 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marion Eye Centers LTDGroup PAC ID 3072426774, 38 clinicians

Practice addresses (Care Compare)

1207 N One Mile Rd
Dexter, MO 63841-1041
Phone (573) 624-4584

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2016023867MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Marion Eye Centers LTD. Optometrist CurrentSince Jul 6, 2016 Accepting new patients
Marion Eye Centers LTD. Optometrist CurrentSince Jul 6, 2016 Accepting new patients

Locations

1200 W Deyoung St
Marion, IL 62959
Phone 61899356861290

117 N Main St
Charleston, MO 63834
Phone (573) 683-2020

297 S Silver Springs Rd
Cpe Girardeau, MO 63703
Phone (573) 651-5200

1207 N One Mile Rd
Dexter, MO 63841
Phone (573) 624-4584

212 S Main St
Sikeston, MO 63801
Phone (573) 472-8181

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, 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": "1469059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775174400000",
    "number": "1558714840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W DEYOUNG ST",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629594437",
            "telephone_number": "618-993-5686",
            "fax_number": "618-997-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 N ONE MILE RD",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638411041",
            "telephone_number": "573-624-4584",
            "fax_number": "573-624-4992"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "117 N Main St",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "MO",
            "postal_code": "638341674",
            "country_code": "US",
            "telephone_number": "573-683-2020",
            "fax_number": "573-683-4003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "212 S Main St",
            "address_purpose": "LOCATION",
            "city": "Sikeston",
            "state": "MO",
            "postal_code": "638013034",
            "country_code": "US",
            "telephone_number": "573-572-8181",
            "fax_number": "573-472-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEATH",
        "first_name": "JACOB",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-21",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2016023867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dexter, MO

Sources for this page

Verify at the official NPI Registry.