Courtney Kay Duberry, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2020018357 Issued in MO

Practice address

915 N Grand Blvd
Saint Louis, MO 63106-1621

Phone

(314) 652-4100

NPI assigned

Sep 8, 2020

Last updated

Sep 8, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Courtney Kay Lewis Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eagan Eye Clinic LLCGroup PAC ID 0345220745, 48 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eagan Eye Clinic LLC

  • Optometrist
  • Eagan, MN
  • NPI 1477732337
  Medicare reassignment Care Compare group NPD
• Eagan Eye Clinic LLC

  • Optometrist
  • Becker, MN
  • NPI 1023615069
  NPD

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1821602756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12805 TOWN AND FOUR DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416222",
            "telephone_number": "763-438-6192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "314-652-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBERRY",
        "first_name": "COURTNEY",
        "middle_name": "KAY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2020018357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "LEWIS",
            "middle_name": "KAY",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carol G. Duane, CPNP
• Alma Astrid Duarte Erazo
• Sandra D Duarte-Sckell, M.D.
• Carla Ruth Duban, MD
• Erik R Dubberke, MD
• Elaine M Dubis, RN
• Ashley Michelle Dubois, CRNA
• David Dubois, MD
• Ryan Dubois
• Ron Dubuque, A.T.C.

• Optometrist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.
• 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.