Trevor H Dickson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

100510 Issued in ID

Practice address

500 S Utah Ave
Idaho Falls, ID 83402-3305

Phone

(208) 709-5371

NPI assigned

Jun 19, 2020

Last updated

Jun 19, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

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.

• Eyedaho Optometric LLC

  • Optometrist
  • Idaho Falls, ID
  • NPI 1417627480
  Medicare reassignment NPD Authorized official
• Eyedaho Optometric LLC

  • Clinic/Center
  • Idaho Falls, ID
  • NPI 1396361358
  Authorized official Same address or phone

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592524800000",
    "number": "1588280176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UTAH AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023305",
            "telephone_number": "208-709-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S UTAH AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023305",
            "telephone_number": "208-709-5371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "TREVOR",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "100510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO OPTOMETRY LICENSE",
            "identifier": "100510",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Dial
• Beatriz Diaz, RD, LD
• Celica Diaz
• Macady Diaz
• John D Dickinson, D.O.
• Jessica M Diviesti, OTR/L
• Dixon Dental Center
• Jessica Lynne Dixon, LPC
• Lorin E Dixon, DMD
• Melissa A Dixon, D.D.S.

• Optometrist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.