Carol Lynn Deitz O D Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

1134DT Issued in KY

Legal business name

CAROL LYNN DEITZ O D INC

Doing business as

Edgewood Eye Center

Practice address

581 Dudley Rd.
Edgewood, KY 41017-3296

Phone

(859) 341-0888

Fax

(859) 341-3386

NPI assigned

Mar 11, 2008

Last updated

Jun 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sheila J King

Title

Manager/Optician

Phone

(859) 341-0888

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Edgewood Eye Center Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 6

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.

• Christopher Jordan Bertke, OD

  • Optometrist
  • Edgewood, KY
  • NPI 1528652831
  Medicare reassignment Care Compare group NPD
• Ian M. Carr, OD

  • Optometrist
  • Edgewood, KY
  • NPI 1104017847
  Medicare reassignment Care Compare group
• Corey Thomas Leach, OD

  • Optometrist
  • Mesa, AZ
  • NPI 1427658921

  KY

  Medicare reassignment NPD
• Carol Deitz-Bertke, O.D.

  • Optometrist
  • Edgewood, KY
  • NPI 1538158860
  Medicare reassignment
• Julie A Herron, O.D.

  • Optometrist
  • Alexandria, KY
  • NPI 1750444212
  NPD (past)
• Sarah Rachel Travis, OD

  • Optometrist
  • Edgewood, KY
  • NPI 1225189806
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1821268392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "581 DUDLEY RD.",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173296",
            "telephone_number": "859-341-0888",
            "fax_number": "859-341-3386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "581 DUDLEY RD.",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173296",
            "telephone_number": "859-341-0888",
            "fax_number": "859-341-3386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROL LYNN DEITZ O D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER/OPTICIAN",
        "authorized_official_telephone_number": "859-341-0888"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1134DT",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "KY",
            "license": "1134DT",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000049502",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Constance Woerman Calvert, NP-C
• Jessica M Carbiener, APRN
• Cardiology Associates, PSC
• Caretenders of Northern Kentucky, Inc. (Caretenders)
• Caretenders VS of Northern Ky, LLC (Caretenders)
• Ian M. Carr, OD
• Thomas Paul Carrigan, MD
• Sarah Casey, APRN
• Lauren Castellini, M.D.
• Mario Castillo-Sang, M.D.

• Optometrist in Edgewood, KY
• Providers in Edgewood, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.