Brett William Fredericksen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100533 Issued in ID

Practice address

291 N Milwaukee St Ste a-3
Boise, ID 83704-9132

Phone

(833) 776-2020

Fax

(208) 297-5718

NPI assigned

Jun 9, 2021

Last updated

Jun 9, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

LWK P CGroup PAC ID 5890824247, 14 clinicians

Eye Pros Treasure ValleyGroup PAC ID 5496129934, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.95 of 100Reported as group

Quality

77.91

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Eye Pros Treasure Valley

  dba Eye Pros

  • Optometrist
  • Meridian, ID
  • NPI 1083370340
  Medicare reassignment Care Compare group NPD
• LWK, P.C.

  dba Eye Pros

  • Optometrist
  • Boise, ID
  • NPI 1851624019
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1194392845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 N COLE RD UNIT 45479",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837111095",
            "telephone_number": "833-776-2020",
            "fax_number": "208-297-2518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 N MILWAUKEE ST STE A-3",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049132",
            "telephone_number": "833-776-2020",
            "fax_number": "208-297-5718"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16448 N Midland Blvd",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836875222",
            "country_code": "US",
            "telephone_number": "833-776-2020",
            "fax_number": "208-297-7518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDERICKSEN",
        "first_name": "BRETT",
        "middle_name": "WILLIAM",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Frazee Whitson, PA-C
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• Fred Meyer Stores Inc (Fred Meyer Pharmacy)
• Hope Ann Fredregill, COTA/L
• Tamara Fredrickson
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• Free Minds LLC
• Lindsay S. Freeborn, PT

• Optometrist in Boise, ID
• Providers in Boise, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.