MEDICARE: DR. DIRCK LOUIS DEKEYSER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	200161249	MO
2	152W00000X	Optometrist	1566	KS

General Provider Information

NPI Number	:	1730281247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIRCK LOUIS DEKEYSER O.D.

Provider Business Mailing Address
First Line	:	PO BOX 953468
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-3468
Country	:	US
Telephone Number	:	913-588-6605
Fax Number	:	913-588-0888

Provider Business Practice Location Address
First Line	:	7400 STATE LINE RD
Second Line	:	SUITE 100
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3444
Country	:	US
Telephone Number	:	913-588-6600
Fax Number	:	916-588-6655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	11/09/2022

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Directions to “ DR. DIRCK LOUIS DEKEYSER O.D.” Practice Location

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