Fort Morgan Eye Care LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

OPT.0002664 Issued in CO

Legal business name

FORT MORGAN EYE CARE LLC

Practice address

1100 Main St
Fort Morgan, CO 80701-2036

Phone

(970) 867-3046

NPI assigned

Nov 17, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Ryan Wiedrich, O.D.NPI 1225287444

Title

Optometrist

Phone

(806) 336-7105

Specialties & licenses 1

Addresses

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, and the practitioner matching its NPPES authorized official.

• Jeffrey Ryan Wiedrich, O.D.

  • Optometrist
  • Fort Morgan, CO
  • NPI 1225287444
  Medicare reassignment NPD Authorized official
• Thomas Dale Stevens, OD

  • Optometrist
  • Fort Morgan, CO
  • NPI 1700910833
  NPD (past)

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

{
    "created_epoch": "1510876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515628800000",
    "number": "1093229718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 MAIN ST",
            "city": "FORT MORGAN",
            "state": "CO",
            "postal_code": "807012036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 MAIN ST",
            "city": "FORT MORGAN",
            "state": "CO",
            "postal_code": "807012036",
            "telephone_number": "970-867-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MORGAN EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-17",
        "last_updated": "2018-01-11",
        "status": "A",
        "authorized_official_last_name": "WIEDRICH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "806-336-7105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CO",
            "license": "OPT.0002664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Fisher
• Tracy Wayne Fisher, RD
• Rosita Flores
• Michael Foncannon, PHARMD, RPH
• Fort Mogan Dental LLC
• Fort Morgan Family Dental
• Fort Morgan Medical Group, PC
• Fort Morgan Orthodontic Center
• Fort Morgan Pediatric Clinic
• Andrea R. Frank, DDS

• Clinic/Center in Fort Morgan, CO
• Providers in Fort Morgan, CO by specialty
• Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; 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.