Jacob Dufour, O.D.

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

AR2754 Issued in AR

Practice address

101 Dawn Dr
Centerton, AR 72719-9314

Phone

(479) 795-1411

Fax

(479) 795-1412

NPI assigned

Aug 27, 2015

Last updated

May 13, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in AR, OK, TX3 enrollments

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 3

Specialty

Optometry

Education

Southern College of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bright Eyes Vision Care, PC

  • Optometrist
  • Rogers, AR
  • NPI 1275116832
  Medicare reassignment NPD Authorized official
• Petty and Petty, P. a.

  dba Centerton Family Eyecare, P.A.

  • Optometrist
  • Centerton, AR
  • NPI 1457412991
  Medicare reassignment NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Sallisaw, OK
  • NPI 1780692723

  TX

  Medicare reassignment NPD
• Northeastern State University College of Optometry

  • Optometrist
  • Tahlequah, OK
  • NPI 1437106333
  Medicare reassignment NPD
• Pediatric Vision Development Center Inc.

  • Vision Therapy Optometrist
  • Centerton, AR
  • NPI 1558427021
  NPD
• Cherokee Nation

  dba Cherokee Nation Public Health

  • Public Health or Welfare Agency
  • Tahlequah, OK
  • NPI 1013884154
  NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Salina, OK
  • NPI 1326054081
  NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Vinita, OK
  • NPI 1558377226
  NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Muskogee, OK
  • NPI 1841207156
  NPD

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1730556580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S 52ND ST STE 102",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588640",
            "telephone_number": "479-657-6006",
            "fax_number": "479-340-0285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DAWN DR",
            "city": "CENTERTON",
            "state": "AR",
            "postal_code": "727199314",
            "telephone_number": "479-795-1411",
            "fax_number": "479-795-1412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 S 52nd St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727588640",
            "country_code": "US",
            "telephone_number": "479-657-6006",
            "fax_number": "479-340-0285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUFOUR",
        "first_name": "JACOB",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-27",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2754",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "AR",
            "license": "2754",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "AR",
            "license": "AR2754",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "WA",
            "license": "OD 60559129",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Michael Daniel, APN
• Tanna Davis
• Kristin M Demott, OT
• Amanda Renae Deppner
• Tracie Leanne Downey, MS OTR/L
• Eugena Nicole Earhart
• Jocelyn Gray Elliott, MD
• Epic Smiles PLLC
• Lance A Faddis, MD
• Stefanie Martin Farinholt, BSOT

• Vision Therapy Optometrist in Centerton, AR
• Providers in Centerton, AR by specialty
• Vision Therapy Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.