Lisa Durham, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2004017331 Issued in MO

Practice address

54 The Legends Pkwy Ste 151
Eureka, MO 63025-3803

Phone

(636) 938-7010

Fax

(636) 938-7141

NPI assigned

Jun 23, 2005

Last updated

Nov 18, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lisa Scheller Former name

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

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisadurham@direct.eyecare-partners.com

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.

• Clarkson Optometry, Inc

  • Optometrist
  • Ellisville, MO
  • NPI 1497155345
  Medicare reassignment Care Compare group NPD
• Clarkson Optometry Inc

  dba Clarkson Eyecare

  • Optometrist
  • Elk River, MN
  • NPI 1952992976
  NPD
• Clarkson Optometry Inc

  dba Clarkson Eyecare

  • Optometrist
  • Pacific, MO
  • NPI 1215980875
  NPD (past)

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416268800000",
    "number": "1629074620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E NORTH ST",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251205",
            "telephone_number": "636-200-4393",
            "fax_number": "636-938-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 THE LEGENDS PKWY STE 151",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630253803",
            "telephone_number": "636-938-7010",
            "fax_number": "636-938-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURHAM",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-23",
        "last_updated": "2014-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2004017331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "318454709",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "318454717",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "SCHELLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine Mary Dickerson
• Jessica Lynn Donaldson, DPT
• Sara Lynn Dowil, OTRL CHT
• John J Dubois, D.O.
• Angela D Duesing
• Brittany Nichole Eaton, NP
• Eureka Fire Protection District of St. Louis County
• Eureka Medical LLC
• Eureka Pain Clinic LLC
• Eureka Pediatrics

• Optometrist in Eureka, MO
• Providers in Eureka, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.