NPIMap

Organization Active NPI

Dr. Michael Wade Jorgensen OD LLC

  • Optometrist
  • Benton, LA
National Provider Identifier
1144677899
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1590623T Issued in LA
Legal business name
DR. MICHAEL WADE JORGENSEN OD LLC
Practice address
187 Burt Blvd
Ste a
Benton, LA 71006-4905
Phone
(318) 935-5080
Fax
(318) 935-5085
NPI assigned
May 23, 2016
Last updated
May 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

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

Authorized official

Name
Dr. Michael Wade Jorgensen, ODNPI 1558675157
Title
Owner/Doctor
Phone
(318) 935-5080

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
Optometrist 152W00000X 1590623T LA Primary

Addresses

Primary practice location

187 Burt Blvd
Ste a
Benton, LA 71006-4905

Mailing address

187 Burt Blvd
Ste a
Benton, LA 71006-4905
Phone (318) 935-5080

Other identifiers 1

IdentifierTypeStateIssuer
2394495MedicaidLA

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463961600000",
    "number": "1144677899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 BURT BLVD",
            "address_2": "STE A",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710064905",
            "telephone_number": "318-935-5080",
            "fax_number": "318-935-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 BURT BLVD",
            "address_2": "STE A",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710064905",
            "telephone_number": "318-935-5080",
            "fax_number": "318-935-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MICHAEL WADE JORGENSEN OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-23",
        "last_updated": "2016-05-23",
        "status": "A",
        "authorized_official_last_name": "JORGENSEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "318-935-5080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1590623T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2394495",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; 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.