Active NPI
Tyler Xavier De Souza, O.D.
- Optometrist
- Tempe, AZ
National Provider Identifier
1972988525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT-002306
- Practice address
- 1831 E Buena Vista Dr
Tempe, AZ 85284-2501 - Phone
- (929) 335-1243
- NPI assigned
- Jul 24, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV008345 | NY | |
| Optometrist | 152W00000X | OPT-002306 | AZ | Primary |
Addresses
Primary practice location
1831 E Buena Vista Dr
Tempe, AZ 85284-2501
Mailing address
6895 E Camelback Rd Unit 3015
Scottsdale, AZ 85251-2480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- New England College of Optometry, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
16427 N Scottsdale Rd
Suite 410
Scottsdale, AZ 85254-7102
Phone (888) 495-4489
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT-002306 | AZ | MD | Optometrist |
| TUV008345 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Onesource Senior Healthcare PLLC | Optometrist | Current | Accepting new patients |
Locations
16427 N Scottsdale Rd
Ste 410
Scottsdale, AZ 85254
Phone (480) 418-1932
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559174400000",
"number": "1972988525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6895 E CAMELBACK RD UNIT 3015",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852512480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1831 E BUENA VISTA DR",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852842501",
"telephone_number": "929-335-1243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE SOUZA",
"first_name": "TYLER",
"middle_name": "XAVIER",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-24",
"last_updated": "2019-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV008345",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "OPT-002306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; 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.