Clark Edward Deshon, O.D., F.A.A.O

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008793 Issued in IL

Practice address

303 E Main St
Olney, IL 62450

Phone

(618) 395-2676

Fax

(618) 395-2720

NPI assigned

Oct 26, 2005

Last updated

Aug 31, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

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

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.74 of 100Reported as individual

Quality

67.59

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Optometric Eyecare Inc.

  • Optometrist
  • Olney, IL
  • NPI 1609041342
  Medicare reassignment NPD Authorized official
• Optometric Eyecare, Inc

  dba Mt. Carmel EyeCare

  • Optometrist
  • Mount Carmel, IL
  • NPI 1952541179
  NPD Authorized official
• Optometric Eyecare, Inc

  dba Olney EyeCare

  • Optometrist
  • Olney, IL
  • NPI 1376789578
  Authorized official Same address or phone

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535673600000",
    "number": "1861482309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E MAIN ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502117",
            "telephone_number": "618-395-2676",
            "fax_number": "618-395-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E MAIN ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "62450",
            "telephone_number": "618-395-2676",
            "fax_number": "618-395-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESHON",
        "first_name": "CLARK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "O.D., F.A.A.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2018-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5290131",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008793",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "09327152",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Destiny R Dannells, NP-C
• Charlotte Davies
• Deaconess Specialty Physicians, Inc
• Deaconess Specialty Physicians, Inc
• Niranat Dejtiranukul, M.D.
• Danielle Renee Deters, PHARMD
• Developmental Specialists of Southeastern Il, Inc.
• Luis C Devenecia Jr., MD
• Dorothea U Diciro, APN, CS
• Lydia Dickey, BS

• Optometrist in Olney, IL
• Providers in Olney, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; 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.