Individual provider Active NPI

Alyssa Vanwerden, OD

  • Optometrist
  • Bloomington, IN
National Provider Identifier
1083340947
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18004339A Issued in IN
Practice address
1105 S College Mall Rd
Bloomington, IN 47401-6177
Phone
(812) 333-2020
Fax
(812) 334-2020
NPI assigned
Jul 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18004339A IN Primary

Addresses

Primary practice location

1105 S College Mall Rd
Bloomington, IN 47401-6177

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220819000777 IN Practitioner - Optometry 4688057995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Indiana LLCGroup PAC ID 5496091316, 82 clinicians

Practice addresses (Care Compare)

1105 S College Mall Rd
Bloomington, IN 47401-6177
Phone (812) 333-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Aug 22, 2022 Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Aug 22, 2022 Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist Current Accepting new patients

Locations

4719 W State Road 46
Bloomington, IN 47404
Phone (812) 876-2020

2901 S McIntire Dr
Bloomington, IN 47403
Phone (812) 332-1401

1105 S College Mall Rd
Bloomington, IN 47401
Phone (812) 333-2020

2901 S McIntire Dr
Ste 120
Bloomington, IN 47403
Phone (812) 332-1401

9760 Lantern Rd
Fishers, IN 46037
Phone (317) 577-9200

804 Broad Ripple Ave
Indianapolis, IN 46220
Phone (317) 257-5421

357 W Morgan St
Ste C
Spencer, IN 47460
Phone (812) 829-1254

506 Wabash Ave
Terre Haute, IN 47807
Phone (812) 232-0073

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1083340947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016177",
            "telephone_number": "812-333-2020",
            "fax_number": "812-334-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANWERDEN",
        "first_name": "ALYSSA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-25",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004339A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.