Individual provider Active NPI

Sarah Elizabeth Dierks, OD

  • Optometrist
  • Papillion, NE
National Provider Identifier
1104054873
Registry record updated Jul 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1322 Issued in NE
Practice address
7474 Towne Center Pkwy
Suite 107
Papillion, NE 68046-4805
Phone
(402) 592-3239
NPI assigned
Jul 1, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1322 NE Primary

Addresses

Primary practice location

7474 Towne Center Pkwy
Suite 107
Papillion, NE 68046-4805

Mailing address

12819 Highview Dr
Plattsmouth, NE 68048-8716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20221201001905 WI Practitioner - Optometry 5698143220 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Packerland Eyecare, LLC Optometrist CurrentSince Jul 19, 2022 Accepting new patients

Locations

19 W Main St
Chilton, WI 53014
Phone (414) 849-4291

Organizations & group practices 1

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": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246406400000",
    "number": "1104054873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12819 HIGHVIEW DR",
            "city": "PLATTSMOUTH",
            "state": "NE",
            "postal_code": "680488716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7474 TOWNE CENTER PKWY",
            "address_2": "SUITE 107",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680464805",
            "telephone_number": "402-592-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERKS",
        "first_name": "SARAH",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2009-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Papillion, NE

Sources for this page

Verify at the official NPI Registry.