Gerrit H. Devries, O.D.
Individual provider Active NPI Optometrist · Demotte, IN
NPI 1992729206 · NPPES record last updated Sep 2, 2010
Key facts
- NPI
- 1992729206
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 18001809B (IN)
- Practice address
- 609 N Halleck St
Demotte, IN 46310-9545 - Phone
- (219) 987-3673
- Fax
- (219) 987-3905
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18001809B | IN | MD | Corneal and Contact Management Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deboer OD LTD | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18001809B | IN | Yes |
| Corneal and Contact Management Optometrist | 152WC0802X | 18001809B | IN | |
| Occupational Vision Optometrist | 152WX0102X | 18001809B | IN | |
| Pediatric Optometrist | 152WP0200X | 18001809B | IN |
Addresses
Primary practice location
609 N Halleck St
Demotte, IN 46310-9545
Mailing address
PO Box 849
Demotte, IN 46310-0849
Phone (219) 987-3673
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100142770A | Medicaid | IN |
Other providers in Demotte, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.