CMS-1500 Box 24J / 33a • NPI
1730556580
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
152WV0400X (CMS 41)
Licensed & Credentialed Eye and Vision Service Providers — Optometrist, Vision Therapy
Box 32 Service Location & ZIP+4
101 DAWN DR, CENTERTON, AR, 72719-9314
✓ 9-Digit EDI 837 ZIP+4 (72719-9314)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1730556580 (JACOB DUFOUR, O.D.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
No
Hospice Referring
✓ Eligible
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1730556580)
Medicare Beneficiaries
32
Total Billed Services
52
Distinct CPT/HCPCS Codes
9
Medicare Allowed Total
$5,215.32
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
92004 | New patient complete exam of visual system | 12 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1730556580 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | JACOB DUFOUR, O.D. |
| Plain-English Specialty | Licensed & Credentialed Eye and Vision Service Providers — Optometrist, Vision Therapy NUCC Code: 152WV0400X (Optometrist, Vision Therapy) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 101 DAWN DR, CENTERTON, AR, 72719-9314 |
| Practice Telephone / Fax | Tel: (479) 795-1411 | Fax: (479) 795-1412 |
| Administrative Mailing Address | 900 S 52ND ST STE 102, ROGERS, AR, 72758-8640 |
| Enumeration & Last Sync | Enumerated: 2015-08-27 | CMS Record Updated: 2021-05-13 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (152WV0400X)
What Does Taxonomy Code 152WV0400X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 152WV0400X translates to:
"Licensed & Credentialed Eye and Vision Service Providers — Optometrist, Vision Therapy"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (JACOB DUFOUR, O.D.)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
152WV0400X — Optometrist, Vision TherapyPlain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist, Vision Therapy | State: AR | License: AR2754 | Primary: Yes (Primary) |
152W00000X — OptometristPlain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist | State: AR | License: 2754 | Primary: Secondary |
152WP0200X — Optometrist, PediatricsPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: AR | License: 2754 | Primary: Secondary |
152WV0400X — Optometrist, Vision TherapyPlain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist, Vision Therapy | State: WA | License: OD 60559129 | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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