Hank D Dehaven, O.D.
Individual provider Active NPI Optometrist · White House, TN
NPI 1790793495 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1790793495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2277 (TN)
- Practice address
- 122 Highway 76
White House, TN 37188-9291 - Phone
- (615) 672-6896
- Fax
- (615) 672-6783
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hermitage Eye Care, PLLC
Practice addresses (Care Compare)
122 Hwy 76
White House, TN 37188-9291
Phone (615) 672-6896
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20050929001329 | TN | Practitioner - Optometry | 3577524925 |
Reassigns benefits to 1 organization Practice locations: White House, TN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2277 | TN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hermitage Eye Care PLLC | Optometrist | Current |
Accepting new patients |
| Hermitage Eye Care PLLC | Optometrist | Past |
Accepting new patients |
Locations
782 Old Hickory Blvd
Ste 204
Brentwood, TN 37027
Phone (615) 373-9992
122 Highway 76
White House, TN 37188
Phone (615) 672-6896
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2277 | TN | Yes |
Addresses
Primary practice location
122 Highway 76
White House, TN 37188-9291
Mailing address
122 Highway 76
White House, TN 37188-9291
Phone (615) 672-6896
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6537319 | Other | TN | CIGNA |
| 3945747 | Medicaid | TN | |
| 4108253 | Other | TN | BLUE CROSS BLUE SHIELD TN |
Other providers in White House, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.