NPIMap

Organization Active NPI

Decleene Optometry, Inc.

  • Optometrist
  • Kokomo, IN
National Provider Identifier
1780739540
Registry record updated Nov 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002523A Issued in IN
Legal business name
DECLEENE OPTOMETRY, INC.
Practice address
608 E Boulevard
Kokomo, IN 46902-2286
Phone
(765) 453-5005
Fax
(765) 453-8937
NPI assigned
Jan 24, 2007
Last updated
Nov 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2014

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

Authorized official

Name
Dr. Frank M. Decleene III, O.D.NPI 1255323226
Title
Optometrist
Phone
(765) 453-5005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002523A IN Primary

Addresses

Primary practice location

608 E Boulevard
Kokomo, IN 46902-2286

Mailing address

608 E Boulevard
Kokomo, IN 46902-2286
Phone (765) 453-5005

Other identifiers 3

IdentifierTypeStateIssuer
100341590MedicaidIN
100341640MedicaidIN
100420590AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050621000370 IN Part B Supplier - Clinic/Group Practice 3274578265 Receives reassigned benefits from 3 practitioners
Practice locations: Kokomo, IN
O20140715001266 IN DME Supplier - Physician - Optometrist 3274578265 Practice locations: Kokomo, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Decleene Optometry, Inc.608 E Boulevard, Kokomo, IN 46902-2286(765) 453-5005 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2011

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415232000000",
    "number": "1780739540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 E BOULEVARD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469022286",
            "telephone_number": "765-453-5005",
            "fax_number": "765-453-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 E BOULEVARD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469022286",
            "telephone_number": "765-453-5005",
            "fax_number": "765-453-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECLEENE OPTOMETRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2014-11-06",
        "status": "A",
        "authorized_official_last_name": "DECLEENE",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "765-453-5005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002523A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100341590",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100341640",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100420590A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.