Daniel Carl Pridemore, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3270-35 Issued in WI

Practice address

2761 S 108TH St
West Allis, WI 53227-3232

Phone

(414) 321-2425

Fax

(414) 321-4647

NPI assigned

Jun 19, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340064000000",
    "number": "1104189877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2761 S 108TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532273232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2761 S 108TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532273232",
            "telephone_number": "414-321-2425",
            "fax_number": "414-321-4647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDEMORE",
        "first_name": "DANIEL",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-19",
        "last_updated": "2012-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3270-35",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020677066",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Care of Wisconsin, LLC.
• Kristina Presnal, PHARMD
• Price Chiropractic Services, LLC
• Kenneth Elon Price, D.C.
• Roberta Prichard, LCSW
• Professional Home Care Services Inc
• Professional Services Group, Inc.
• David E Pryba, MD
• Theresa Lynn Pucylowski, RPH
• Ronald Paul Pupp, PH.D.

• Optometrist in West Allis, WI
• Providers in West Allis, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.