Deboer OD LTD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002342 Issued in IN

Legal business name

DEBOER OD LTD

Doing business as

DeBoer Family Eyecare

Practice address

609 N Halleck St
Demotte, IN 46310-9545

Phone

(219) 987-3673

NPI assigned

Aug 8, 2006

Last updated

Dec 29, 2011By 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

Dr. Timothy J Deboer, OD

Title

President

Phone

(219) 987-3673

Specialties & licenses 1

Addresses

Other names 1

• DeBoer Family Eyecare Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 5

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.

• Kevin Johnson, OD

  • Optometrist
  • Lowell, IN
  • NPI 1538246855
  Medicare reassignment Care Compare group NPD
• John Mark Deboer, O.D.

  • Optometrist
  • Demotte, IN
  • NPI 1770566556
  Medicare reassignment Care Compare group
• Brant Tregellas Molenaar, OD

  • Optometrist
  • Lansing, IL
  • NPI 1942307053

  IN

  Medicare reassignment Care Compare group
• Gerrit H. Devries, O.D.

  • Optometrist
  • Demotte, IN
  • NPI 1992729206
  NPD (past)
• John J Rimkus, O.D.

  • Optometrist
  • Peoria, IL
  • NPI 1346347044
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1972513653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849",
            "address_2": "609 N. HALLECK STREET",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463100849",
            "telephone_number": "219-987-3673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 N HALLECK ST",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463109545",
            "telephone_number": "219-987-3673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEBOER OD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2011-12-29",
        "status": "A",
        "authorized_official_last_name": "DEBOER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-987-3673",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeBoer Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassie Cox, CCC-SLP
• Sydney Nicole Cox
• Creative Spirit Counseling LLC
• Crestmark of Roselawn
• De Boer OD., LTD (De Boer Family Eyecare)
• John Mark Deboer, O.D.
• Kevin John Defries, D.C.
• Demotte Physicians Inc.
• Gerrit H. Devries, O.D.
• Judy C Dewitt

• Optometrist in Demotte, IN
• Providers in Demotte, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; 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.