Brittany Rae Disterheft, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18004052A Issued in IN

Practice address

13115 Wicker Ave Ste E
Cedar Lake, IN 46303-7400

Phone

(219) 374-7800

Fax

(219) 374-5196

NPI assigned

Jul 27, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Optometry

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Illiana Eyecare IncGroup PAC ID 9133223373, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Illiana Eyecare Inc

  • Optometrist
  • Cedar Lake, IN
  • NPI 1215040142
  Medicare reassignment Care Compare group NPD
• Holicki Eye Centers, P.C.

  • Ophthalmology Physician
  • Coldwater, MI
  • NPI 1811980386

  IN

  Medicare reassignment
• Holicki Optical Inc

  • Optometrist
  • Angola, IN
  • NPI 1821382714
  NPD (past)

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1760906135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 DORCHESTER LN UNIT 1",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "463752640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13115 WICKER AVE STE E",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463037400",
            "telephone_number": "219-374-7800",
            "fax_number": "219-374-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTERHEFT",
        "first_name": "BRITTANY",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-27",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004052A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean Marie Decavitch, NP-C
• Jenna Marie Demy, PHARMD.
• Detailed Dental
• Thomas Leroy Dexter III
• Brian Vincent Dieckmann, PSYD
• Lisa Antoinette Duffley-Kazmierski, D.T.
• Edgewater Systems for Balanced Living, Inc (Edgewater Health: Cedar Lake)
• Empower Workforce Solutions LLC
• Flexeon Rehabilitation of Cedar Lake, LLC
• Ryan Flipse, PT

• Optometrist in Cedar Lake, IN
• Providers in Cedar Lake, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.