Individual provider Active NPI

Daniel John Weber, O.D.

  • Optometrist
  • Clinton, MO
National Provider Identifier
1669521753
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2020034823 Issued in MO
Practice address
1602 N 2ND St
Clinton, MO 64735-1192
Phone
(660) 885-8171
Fax
(660) 890-8496
NPI assigned
Jan 9, 2007
Last updated
Aug 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2020034823 MO Primary

Addresses

Primary practice location

1602 N 2ND St
Clinton, MO 64735-1192

Mailing address

1602 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-8171

Other practice location 1

4214 N Harlem Ave
Norridge, IL 60706-1204
Phone (708) 453-6644

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210409000911 MO Practitioner - Optometry 4688710148 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1602 N 2ND St
Golden Valley Medical Clinton
Clinton, MO 64735-1192
Phone (660) 890-8023

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2020034823MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Valley Memorial Hospital District CurrentSince Jun 1, 2021 Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Jun 1, 2021 Accepting new patients
Luxottica of America Inc Past Accepting new patients
Luxottica of America Inc. Past Accepting new patients

Locations

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1602 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

Interoperability endpoints

  • Direct secure messaging: djweber@gvmh.direct.eyemdemr.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1669521753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171",
            "fax_number": "660-890-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171",
            "fax_number": "660-890-8496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4214 N Harlem Ave",
            "address_purpose": "LOCATION",
            "city": "Norridge",
            "state": "IL",
            "postal_code": "607061204",
            "country_code": "US",
            "telephone_number": "708-453-6644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEBER",
        "first_name": "DANIEL",
        "middle_name": "JOHN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2020034823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MO

Sources for this page

Verify at the official NPI Registry.