Jerry R. Pederson, O.D., P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

JERRY R. PEDERSON, O.D., P.C.

Doing business as

Southglenn EyeCare, PC

Practice address

6650 S Vine St
Suite 160
Centennial, CO 80121-2769

Phone

(303) 798-5533

Fax

(303) 798-2800

NPI assigned

Jul 13, 2009

Organization subpart

No

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

Authorized official

Name

Jon F Pederson, O.D.NPI 1407842628

Title

Owner

Phone

(303) 798-5533

Specialties & licenses 1

Addresses

Other names 1

• Southglenn EyeCare, PC Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

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

• Jon F Pederson, OD

  • Corneal and Contact Management Optometrist
  • Centennial, CO
  • NPI 1407842628
  Medicare reassignment Care Compare group Authorized official
• Samantha Kincaid, O.D.

  • Corneal and Contact Management Optometrist
  • Parker, CO
  • NPI 1629483144
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1073742938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6650 S VINE ST",
            "address_2": "SUITE 160",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801212769",
            "telephone_number": "303-798-5533",
            "fax_number": "303-798-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 S VINE ST",
            "address_2": "SUITE 160",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801212769",
            "telephone_number": "303-798-5533",
            "fax_number": "303-798-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY R. PEDERSON, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-798-5533",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southglenn EyeCare, PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southglenn EyeCare, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenny Nickerson
• Hannah Jensen
• Dawn Marie Jenson, MSPT
• Jeremyj. Zeigler DMD, PLLC
• Jerry R. Pederson, O.D.
• Jessica Kruckeberg
• Joshua Jewell
• Jill Tullman & Associates, LLC
• Kara Sunshine Jindrich, MD
• JM Pharmacy Services LLC

• Optometrist in Centennial, CO
• Providers in Centennial, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; 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.