Dustin William Anderson
Individual provider Active NPI Optometrist · Fenton, MO
NPI 1821640517 · NPPES record last updated Oct 7, 2024
Key facts
- NPI
- 1821640517
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2019021861 (MO)
- Practice address
- 1011 Bowles Ave Ste 200
Fenton, MO 63026-2384 - Phone
- (636) 717-1700
- Fax
- (636) 203-4727
- NPI assigned
- Jul 12, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Envision Eye Specialists PC
Practice addresses (Care Compare)
1011 Bowles Ave
Suite 200
Fenton, MO 63026-2384
Phone (636) 717-1700
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.88 of 100
- Quality
- 83.76
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20190726001140 | MO | Practitioner - Optometry | 3476889544 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019021861 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Envision Eye Specialists PC | Current |
Accepting new patients |
Locations
3619 Richardson Square Dr
Ste 100
Arnold, MO 63010
Phone (636) 717-6700
1011 Bowles Ave
Ste 115
Fenton, MO 63026
Phone (636) 343-6664
1011 Bowles Ave
Ste 200
Fenton, MO 63026
Phone (636) 343-6664
Interoperability endpoints
- dustinanderson@direct.eyecare-partners.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2019021861 | MO | Yes |
Addresses
Primary practice location
1011 Bowles Ave Ste 200
Fenton, MO 63026-2384
Mailing address
PO Box 207158
Dallas, TX 75320-7158
Phone (636) 200-4393
Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2024. 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.