NPIMap

Organization Active NPI

Michael Petruska OD PC

  • Optometrist
  • Richmond, VA
National Provider Identifier
1124179494
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG001776 Issued in PA
Legal business name
MICHAEL PETRUSKA OD PC
Practice address
2501 Sheila LN
Richmond, VA 23225-2041
Phone
(804) 320-9457
Fax
(804) 320-9458
NPI assigned
Jan 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Michael Petruska, O.D.NPI 1508970856
Title
President
Phone
(484) 223-6930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OEG001776 PA Primary

Addresses

Primary practice location

2501 Sheila LN
Richmond, VA 23225-2041

Mailing address

4379 Eisenhower Dr
Bethlehem, PA 18020-8937
Phone (610) 759-0806

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124179494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4379 EISENHOWER DR",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180208937",
            "telephone_number": "610-759-0806",
            "fax_number": "610-515-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 SHEILA LN",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232252041",
            "telephone_number": "804-320-9457",
            "fax_number": "804-320-9458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL PETRUSKA OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETRUSKA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-223-6930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG001776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.