Individual provider Active NPI

Dennis E Dettmann, O.D.

  • Optometrist
  • Plainfield, IL
National Provider Identifier
1609877455
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046007054 Issued in IL
Practice address
21219 Silktree Cir
Plainfield, IL 60544-9359
Phone
(630) 257-6493
Fax
(630) 243-6293
NPI assigned
Aug 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046007054 IL Primary

Addresses

Primary practice location

21219 Silktree Cir
Plainfield, IL 60544-9359

Mailing address

21219 Silktree Cir
Plainfield, IL 60544-9359
Phone (630) 257-6493

Other identifiers 1

IdentifierTypeStateIssuer
046007054MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040812000233 IL Practitioner - Optometry 8224017587 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rosin Optical Co IncGroup PAC ID 8022921758, 51 clinicians

Practice addresses (Care Compare)

6233 Cermak Rd
Berwyn, IL 60402-2317
Phone (708) 749-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
046007054ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rosin Optical Co., Inc. Optometrist CurrentSince May 1, 2016 Accepting new patients
Rosin Optical Co. Inc. Optometrist CurrentSince May 1, 2016 Accepting new patients
Rosin Optical Co., Inc Optometrist Current Accepting new patients
Dennis Dettmann, O.D. S.C. Optometrist CurrentSince Jul 2, 1987 Accepting new patients

Locations

6235 Cermak Rd
Berwyn, IL 60402
Phone (708) 749-2020

145 Ogden Ave
Downers Grove, IL 60515
Phone (630) 749-2020

6131 Park Ridge Rd
Loves Park, IL 61111
Phone (815) 543-0545

4141 N Rockton Ave
Rockford, IL 61103
Phone (815) 316-1500

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1609877455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21219 SILKTREE CIR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605449359",
            "telephone_number": "630-257-6493",
            "fax_number": "630-243-6293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21219 SILKTREE CIR",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605449359",
            "telephone_number": "630-257-6493",
            "fax_number": "630-243-6293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTMANN",
        "first_name": "DENNIS",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007054",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

Verify at the official NPI Registry.