Active NPI
Therese B Dahl, OD
- Optometrist
- Titusville, FL
National Provider Identifier
1992878771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPL1525
- Practice address
- 3659 South Hopkins Ave
Suite D
Titusville, FL 32780 - Phone
- (321) 264-4264
- Fax
- (321) 264-9433
- NPI assigned
- Nov 17, 2006
- Sex
- Female
- Sole proprietor
- No
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 | OPL1525 | FL | Primary |
| Optometrist | 152W00000X | 1532 | WI |
Addresses
Primary practice location
3659 South Hopkins Ave
Suite D
Titusville, FL 32780
Mailing address
3659 South Hopkins Ave
Suite D
Titusville, FL 32780
Phone (321) 264-4264
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27596 | Other | AVESIS | |
| 078593800 | Medicaid | FL | |
| 114116 | Other | EYEMED | |
| 1213330001 | Other | DMNS CLEARING HOUSE | |
| 180004904 | Other | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| OPL1525 | FL | MD | Optometrist |
| 1532 | WI | MD | Optometrist |
| 1525 | FL | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233705600000",
"number": "1992878771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3659 SOUTH HOPKINS AVE",
"address_2": "SUITE D",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "32780",
"telephone_number": "321-264-4264",
"fax_number": "321-264-9433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3659 SOUTH HOPKINS AVE",
"address_2": "SUITE D",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "32780",
"telephone_number": "321-264-4264",
"fax_number": "321-264-9433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAHL",
"first_name": "THERESE",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-17",
"last_updated": "2009-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPL1525",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1532",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVESIS",
"identifier": "27596",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "078593800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "114116",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMNS CLEARING HOUSE",
"identifier": "1213330001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "180004904",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Titusville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.