Active NPI
Johnna Dukes, ABOC
- Optician
- Spirit Lake, IA
National Provider Identifier
1629399910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 155315
- Practice address
- 1306 18TH St
Suite E
Spirit Lake, IA 51360-1163 - Phone
- (712) 336-4401
- Fax
- (712) 336-4403
- NPI assigned
- Jun 21, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 155315 | IA | Primary |
Addresses
Primary practice location
1306 18TH St
Suite E
Spirit Lake, IA 51360-1163
Mailing address
1306 18TH St
Suite E
Spirit Lake, IA 51360-1163
Phone (712) 336-4401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 155315 | IA | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tarra Vander Leest OD PC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Optometrist
- Spirit Lake, IA
- NPI 1194806117
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364428800000",
"number": "1629399910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1306 18TH ST",
"address_2": "SUITE E",
"city": "SPIRIT LAKE",
"state": "IA",
"postal_code": "513601163",
"telephone_number": "712-336-4401",
"fax_number": "712-336-4403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 18TH ST",
"address_2": "SUITE E",
"city": "SPIRIT LAKE",
"state": "IA",
"postal_code": "513601163",
"telephone_number": "712-336-4401",
"fax_number": "712-336-4403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUKES",
"first_name": "JOHNNA",
"credential": "ABOC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-21",
"last_updated": "2013-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "IA",
"license": "155315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spirit Lake, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.