NPIMap

Organization Active NPI

Desloge Vision Center Inc

  • Eyewear Supplier
  • Desloge, MO
National Provider Identifier
1720128846
Registry record updated Aug 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
DESLOGE VISION CENTER INC
Practice address
1136 N Desloge Dr Ste C
Desloge, MO 63601-2900
Phone
(573) 518-0001
Fax
(573) 518-0081
NPI assigned
Feb 7, 2007
Last updated
Aug 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2008

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

Authorized official

Name
Mrs. Mona J Spiker
Title
Office Manager
Phone
(573) 518-0001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

1136 N Desloge Dr Ste C
Desloge, MO 63601-2900

Mailing address

1136 N Desloge Dr Ste C
Desloge, MO 63601-2900
Phone (573) 518-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041027001017 MO Part B Supplier - Clinic/Group Practice 7012979511 Receives reassigned benefits from 11 practitioners
Practice locations: Desloge, MO

National Provider Directory

National Provider Directory

Locations

1133 N Desloge Dr
Desloge, MO 63601
Phone (573) 518-0001

1136 N Desloge Dr
Ste C
Desloge, MO 63601
Phone (573) 431-5183

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219968000000",
    "number": "1720128846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 N DESLOGE DR STE C",
            "city": "DESLOGE",
            "state": "MO",
            "postal_code": "636012900",
            "telephone_number": "573-518-0001",
            "fax_number": "573-518-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 N DESLOGE DR STE C",
            "city": "DESLOGE",
            "state": "MO",
            "postal_code": "636012900",
            "telephone_number": "573-518-0001",
            "fax_number": "573-518-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESLOGE VISION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-08-29",
        "status": "A",
        "authorized_official_last_name": "SPIKER",
        "authorized_official_first_name": "MONA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "573-518-0001",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Desloge, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; 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.