DR. NATHAN D DEDERMAN OD, FAAO
NPI 1174005243
Optometrist in Fort Leonard Wood, MO

Q: What is Nathan Dederman's NPI number?

The NPI number for Nathan Dederman is 1174005243. It was assigned to this individual provider in the NPPES registry on September 5, 2018.

Q: What is Nathan Dederman's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Nathan Dederman was last updated on January 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 05, 2018

4430 MISSOURI AVE # 1267, FORT LEONARD WOOD, MO 65473(505) 249-9251 Get Directions Write a Review

NPPES record last updated: January 12, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 17, 2023, Sep 5, 2018 (2 updates tracked since 2018).

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About Dr. Nathan D Dederman Od, Faao NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. NATHAN D DEDERMAN OD, FAAO (NPI 1174005243) is an individual optometrist in Fort Leonard Wood, Missouri, licensed in Tennessee (3451) and active in the NPI registry since September 2018.

NPPES Registry Identity

NPI1174005243

Entity TypeIndividualMale

Primary Taxonomy152W00000X

Provider Legal NameDR. NATHAN D DEDERMANCredential: OD, FAAO

Location Address4430 MISSOURI AVE # 1267Fort Leonard Wood, MO 65473-9098

Mailing Address4430 Missouri Ave # 1267Fort Leonard Wood, MO 65473-9098 · (573) 596-0048

Phone(505) 249-9251

Sole ProprietorNo

Enumeration DateSeptember 5, 2018

Last NPPES UpdateJanuary 12, 20242 updates tracked since enumeration

NPPES CertifiedAugust 29, 2023

✔ NPI 1174005243 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in TN · 3451

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

4430 MISSOURI AVE # 1267, Fort Leonard Wood, MO 65473

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Other Identifiers 2

Other10002TX · State License

Other3451TN · State License

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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