Dan L Stadelman, O.D.
Individual provider Active NPI Optometrist · Davenport, IA
NPI 1770501801 · NPPES record last updated Sep 7, 2021
Key facts
- NPI
- 1770501801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 01826 (IA)
- Practice address
- 1718 E Kimberly Rd
Davenport, IA 52807-2097 - Phone
- (563) 355-3912
- Fax
- (563) 359-4108
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lifetime Eyehealth Associates PC
Practice addresses (Care Compare)
1718 E Kimberly Rd
Davenport, IA 52807-2097
Phone (563) 355-3912
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041122000480 | IA | Practitioner - Optometry | 2668436759 |
Reassigns benefits to 1 organization Receives reassigned benefits from 1 practitioner Practice locations: Davenport, IA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifetime Eyehealth Associates PC | Optometrist | Current |
Accepting new patients |
| Palouse Foot & Ankle Clinic PS | Past |
Accepting new patients |
Locations
1718 E Kimberly Rd
Davenport, IA 52807
Phone (563) 355-3912
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 01826 | IA | Yes |
Addresses
Primary practice location
1718 E Kimberly Rd
Davenport, IA 52807-2097
Mailing address
1718 E Kimberly Rd
Davenport, IA 52807-2029
Phone (563) 355-3912
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0224626 | Medicaid | IA | |
| 22462 | Other | IA | BC/BS OF IA |
Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.