Active NPI
Dale David Laird, M.D.
- Ophthalmology Physician
- Loch Lloyd, MO
National Provider Identifier
1790073450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- R4200
- Practice address
- 30 Hever Knoll
Loch Lloyd, MO 64012 - Phone
- (816) 322-1052
- NPI assigned
- Jul 15, 2011
- Last updated
- Jul 15, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | R4200 | MO | Primary |
Addresses
Primary practice location
30 Hever Knoll
Loch Lloyd, MO 64012
Mailing address
30 Hever Knoll
Loch Lloyd, MO 64012
Phone (816) 322-1052
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150304000056 | MO | Order and Referring Only - Ophthalmology | 8921324203 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310688000000",
"number": "1790073450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 HEVER KNOLL",
"city": "LOCH LLOYD",
"state": "MO",
"postal_code": "64012",
"telephone_number": "816-322-1052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 HEVER KNOLL",
"city": "LOCH LLOYD",
"state": "MO",
"postal_code": "64012",
"telephone_number": "816-322-1052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAIRD",
"first_name": "DALE",
"middle_name": "DAVID",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-15",
"last_updated": "2011-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MO",
"license": "R4200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.