Active NPI
Elmo Clyde Dean Jr., O.D.
- Optometrist
- Baton Rouge, LA
National Provider Identifier
1972595460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 843-071T
- Practice address
- 4747 Oneal LN
Ste. a
Baton Rouge, LA 70817-1638 - Phone
- (225) 755-0988
- Fax
- (225) 755-3235
- NPI assigned
- Aug 19, 2005
- Last updated
- Jan 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 843-071T | LA | Primary |
Addresses
Primary practice location
4747 Oneal LN
Ste. a
Baton Rouge, LA 70817-1638
Mailing address
4747 Oneal LN
Ste. a
Baton Rouge, LA 70817-1638
Phone (225) 755-0988
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1317918 | Medicaid | LA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 843 | LA | MD | Chiropractor |
| 843-071T | LA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lahaye Total Eye Care of Lake Charles, Inc | 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.
-
- Clinic/Center
- Lake Charles, LA
- NPI 1497742613
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294617600000",
"number": "1972595460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4747 ONEAL LN",
"address_2": "STE. A",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708171638",
"telephone_number": "225-755-0988",
"fax_number": "225-755-3235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4747 ONEAL LN",
"address_2": "STE. A",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708171638",
"telephone_number": "225-755-0988",
"fax_number": "225-755-3235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAN",
"first_name": "ELMO",
"middle_name": "CLYDE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-19",
"last_updated": "2011-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "LA",
"license": "843-071T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1317918",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.