Raymond P Dickey, OD
Individual provider Active NPI Optometrist · Port Lavaca, TX
NPI 1801808530 · NPPES record last updated Jun 13, 2008
Key facts
- NPI
- 1801808530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 03335TG (TX)
- Practice address
- 420 N Virginia
Port Lavaca, TX 77979-0185 - Phone
- (361) 552-3445
- Fax
- (361) 552-5483
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 03335TG | TX | Yes |
Addresses
Primary practice location
420 N Virginia
Port Lavaca, TX 77979-0185
Mailing address
PO Box 185
420 N Virginia
Port Lavaca, TX 77979-0185
Phone (361) 552-3445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 093219602 | Medicaid | TX | |
| 781242 | Other | HIGHMARK BCBS CLARITY VIS |
Other providers in Port Lavaca, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.