Jerry D Warthman, O.D., LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002286A Issued in IN

Legal business name

JERRY D WARTHMAN, O.D., LLC

Practice address

1923 W 53Rd St
Anderson, IN 46013-1109

Phone

(765) 644-0060

Fax

(765) 644-0076

NPI assigned

Aug 4, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerry Dale Warthman, ODNPI 1063493906

Title

Owner

Phone

(765) 644-0060

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry Dale Warthman, O.D.

  • Optometrist
  • Anderson, IN
  • NPI 1063493906
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1053577510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 W 53RD ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460131109",
            "telephone_number": "765-644-0060",
            "fax_number": "765-644-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 W 53RD ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460131109",
            "telephone_number": "765-644-0060",
            "fax_number": "765-644-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY D WARTHMAN, O.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "WARTHMAN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-644-0060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002286A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100331000B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200953040",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Anderson, IN
• Providers in Anderson, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.