Active NPI
Dennis D Tieszen, OD
- Optometrist
- Waterloo, IA
National Provider Identifier
1952452831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 01790
- Practice address
- 999 Home PLZ
Suite 100
Waterloo, IA 50701-4822 - Phone
- (319) 236-0815
- NPI assigned
- Jan 16, 2007
- Last updated
- Dec 22, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 01790 | IA | Primary |
Addresses
Primary practice location
999 Home PLZ
Suite 100
Waterloo, IA 50701-4822
Mailing address
999 Home PLZ
Suite 100
Waterloo, IA 50701-4822
Phone (319) 236-0815
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410030429 | Other | IA | MEDICARE ID |
| 0117267 | Medicaid | IA | |
| CG4244 | Other | IA | MEDICARE ID |
| 18418 | Other | IA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iowa Eyecare Associates PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261440000000",
"number": "1952452831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "999 HOME PLZ",
"address_2": "SUITE 100",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507014822",
"telephone_number": "319-236-0815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "999 HOME PLZ",
"address_2": "SUITE 100",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507014822",
"telephone_number": "319-236-0815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIESZEN",
"first_name": "DENNIS",
"middle_name": "D",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2009-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "01790",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "410030429",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0117267",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "CG4244",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "18418",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.