Andrea Kaye Dietz, O.D.
Individual provider Active NPI Optometrist · Minster, OH
NPI 1649568577 · NPPES record last updated Mar 11, 2021
Key facts
- NPI
- 1649568577
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 6031/T2946 (OH)
- Practice address
- 208 N Main St
Minster, OH 45865-1121 - Phone
- (419) 628-3017
- Fax
- (419) 628-8208
- NPI assigned
- Jul 12, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ohio State University - College of Optometry, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dietz Eye Care and Associates LLC
Practice addresses (Care Compare)
208 N Main St
Minster, OH 45865-1121
Phone (419) 628-3017
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110812000551 | OH | Practitioner - Optometry | 8729257456 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6031 | OH | MD | Clinical Psychologist |
| 6031/T2946 | OH | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dietz Eye Care & Associates LLC | Optometrist | Current |
Accepting new patients |
| Springboro Vision, LLC | Optometrist | Past |
Accepting new patients |
| Kara S Hampton | Optometrist | Past | Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Locations
2765 Fort Amanda Rd
Ste 100
Lima, OH 45805
Phone (419) 228-3937
208 N Main St
Minster, OH 45865
Phone (419) 628-3017
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 6031/T2946 | OH | Yes |
Addresses
Primary practice location
208 N Main St
Minster, OH 45865-1121
Mailing address
08736 New Bremen New Knoxvle Rd
New Bremen, OH 45869-9755
Phone (419) 733-9109
Other practice location 1
2765 Fort Amanda Rd
Lima, OH 45805-4813
Phone (419) 228-3937
Other providers in Minster, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.