Edmund Leo Prendergast Jr., OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

666D Issued in WV

Practice address

651 Water St
Summersville, WV 26651

Phone

(304) 872-5678

Fax

(304) 872-5697

NPI assigned

Jun 20, 2006

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

Other names 1

• Dr. Eddie L Prendergast Professional name

Medicare fee-for-service enrollment

Enrolled in WV

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1134165251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "CAMDEN ON GAULEY",
            "state": "WV",
            "postal_code": "262080069",
            "telephone_number": "304-226-5725",
            "fax_number": "304-872-5697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 WATER ST",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "26651",
            "telephone_number": "304-872-5678",
            "fax_number": "304-872-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENDERGAST",
        "first_name": "EDMUND",
        "middle_name": "LEO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "666D",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150410000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDDIE",
            "last_name": "PRENDERGAST",
            "middle_name": "L",
            "prefix": "DR.",
            "credential": "OPTOMETRIST OD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gloria N Post
• Stephen Dewayne Postalwait
• Amber Jane Potasnik, PTA
• Sarah Jane Prather
• Premier Women's Hospital
• Myra D. Priddy, MD
• Shandace Pritt, LPN
• Sherry Lynn Proctor
• Taylor M Proctor
• Professional Medical Ultrasonics Inc.

• Optometrist in Summersville, WV
• Providers in Summersville, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.