Active NPI
Richard T Pedersen, OD
- Optometrist
- Colorado Springs, CO
National Provider Identifier
1164493631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 860
- Practice address
- 1625 E Platte Ave
Colorado Springs, CO 80909-5620 - Phone
- (719) 634-4327
- Fax
- (719) 633-0284
- NPI assigned
- Jan 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 860 | CO | Primary |
Addresses
Primary practice location
1625 E Platte Ave
Colorado Springs, CO 80909-5620
Mailing address
1625 E Platte Ave
Colorado Springs, CO 80909-5620
Phone (719) 634-4327
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 860 | CO | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209686400000",
"number": "1164493631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 E PLATTE AVE",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095620",
"telephone_number": "719-634-4327",
"fax_number": "719-633-0284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 E PLATTE AVE",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809095620",
"telephone_number": "719-634-4327",
"fax_number": "719-633-0284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "RICHARD",
"middle_name": "T",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2008-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CO",
"license": "860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.