Organization Active NPI

Dependable Eye Care Inc

  • Optometrist
  • Chestertown, MD
National Provider Identifier
1720004203
Registry record updated Jan 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14210276TRADER Issued in MD
Legal business name
DEPENDABLE EYE CARE INC
Practice address
916 Washington Ave
Chestertown, MD 21620
Phone
(410) 778-0094
Fax
(410) 778-3454
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2012

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

Authorized official

Name
Ms. Linda R Keating, OPTICIAN
Title
Owner Vice President
Phone
(410) 778-0094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 14210276TRADER MD Primary

Addresses

Primary practice location

916 Washington Ave
Chestertown, MD 21620

Mailing address

PO Box 612
916 Washington Ave
Chestertown, MD 21620
Phone (410) 778-0094

Other identifiers 3

IdentifierTypeStateIssuer
406118700MedicaidMD
J989OtherMDBSDC
217BDEOtherMDBSMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041123001269 MD Part B Supplier - Clinic/Group Practice 8729043229 Receives reassigned benefits from 1 practitioner
Practice locations: Chestertown, MD
O20200408001573 MD DME Supplier - Optician 8729043229 Practice locations: Chestertown, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325548800000",
    "number": "1720004203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 612",
            "address_2": "916 WASHINGTON AVE",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "21620",
            "telephone_number": "410-778-0094",
            "fax_number": "410-778-3454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 WASHINGTON AVE",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "21620",
            "telephone_number": "410-778-0094",
            "fax_number": "410-778-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPENDABLE EYE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2012-01-03",
        "status": "A",
        "authorized_official_last_name": "KEATING",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER VICE PRESIDENT",
        "authorized_official_telephone_number": "410-778-0094",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "14210276TRADER",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "406118700",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSDC",
            "identifier": "J989",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSMD",
            "identifier": "217BDE",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chestertown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.