Provider Demographics
NPI:1730281247
Name:DEKEYSER, DIRCK LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DIRCK
Middle Name:LOUIS
Last Name:DEKEYSER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 953468
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-3468
Mailing Address - Country:US
Mailing Address - Phone:913-588-6605
Mailing Address - Fax:913-588-0888
Practice Address - Street 1:7400 STATE LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3444
Practice Address - Country:US
Practice Address - Phone:913-588-6600
Practice Address - Fax:916-588-6655
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200161249152W00000X
KS1566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84572Medicare UPIN