Brynn Peterson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3407-35 Issued in WI

Practice address

4622 Mormon Coulee Rd
La Crosse, WI 54601

Phone

(608) 788-9564

NPI assigned

Oct 10, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, ND2 enrollments

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 2

Specialty

Optometry

Education

Pacific University - College of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Fargo Eyecare Associates PCGroup PAC ID 0244507754, 5 clinicians

Eyecare Associates, PCGroup PAC ID 0648239301, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brynn@fargoeyecare.eyeclinicdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eyecare Associates, PC

  • Optometrist
  • Fargo, ND
  • NPI 1811077100
  Medicare reassignment Care Compare group NPD
• West Fargo Eyecare Associates PC

  • Optometrist
  • West Fargo, ND
  • NPI 1871031153
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547769600000",
    "number": "1164774402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4622 MORMON COULEE RD",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546018224",
            "telephone_number": "608-788-9564",
            "fax_number": "608-788-9562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4622 MORMON COULEE RD",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "54601",
            "telephone_number": "608-788-9564"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2043 College Way",
            "address_purpose": "LOCATION",
            "city": "Forest Grove",
            "state": "OR",
            "postal_code": "971161756",
            "country_code": "US",
            "telephone_number": "701-226-0995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BRYNN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-10",
        "last_updated": "2019-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3407-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luke Oiva Pesonen, MD
• Peter Frandsen Pediatric Dentistry, LLC
• Antoinette M Peters, MD
• Timothy Lou Petersen, RN
• Bethany Lynne Peterson, PT
• Dianne L. Peterson, BSW
• Emily Elizabeth Peterson, PA
• Greggory Lyle Peterson, MD
• Harry J Peterson, MA
• Jacob R Peterson, AA

• Optometrist in La Crosse, WI
• Providers in La Crosse, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.