MEDICARE: DR. DUANE DOUGLAS DEEDS 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	4832	OH
2	152W00000X	Optometrist	961-OD	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851391007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUANE DOUGLAS DEEDS O.D.

Provider Business Mailing Address
First Line	:	11139 COUNTY ROAD 1
Second Line	:
City	:	CHESAPEAKE
State	:	OH
Zip	:	45619-7015
Country	:	US
Telephone Number	:	740-867-4411
Fax Number	:	740-867-8416

Provider Business Practice Location Address
First Line	:	11139 COUNTY ROAD 1
Second Line	:
City	:	CHESAPEAKE
State	:	OH
Zip	:	45619-7015
Country	:	US
Telephone Number	:	740-867-4411
Fax Number	:	740-867-8416

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	09/10/2012

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