Todd M Wiedell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2945 Issued in MN

Practice address

30960 Government Dr
Pequot Lakes, MN 56472-1003

Phone

(218) 568-5555

Fax

(218) 568-8904

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

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

Indiana University - School of Optometry, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Todd M. Wiedel, O.D., PA

  dba Crosslake Eye Center

  • Optometrist
  • Pequot Lakes, MN
  • NPI 1831428903
  Medicare reassignment Authorized official
• John Kloster

  dba Pequot Eye Center

  • Optometrist
  • Pequot Lakes, MN
  • NPI 1396918884
  NPD (past)

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548028800000",
    "number": "1295781425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 176",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564720176",
            "telephone_number": "218-568-5555",
            "fax_number": "218-568-8904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30960 GOVERNMENT DR",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564721003",
            "telephone_number": "218-568-5555",
            "fax_number": "218-568-8904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13833 Riverwood Ln Ste 3",
            "address_purpose": "LOCATION",
            "city": "Crosslake",
            "state": "MN",
            "postal_code": "564422823",
            "country_code": "US",
            "telephone_number": "218-692-4700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEDELL",
        "first_name": "TODD",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2019-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176684800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "314L2WI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2202446",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly A Spray, CNP
• St. Joseph's Medical Center (Essentia Health St. Joseph's-Pequot Lakes Clinic)
• Payden Strange
• Carrie Taylor, PT
• Todd M. Wiedel, O.D., PA (Crosslake Eye Center)
• Violet Marie Wurtzberger, MS, LPCC, LADC

• Optometrist in Pequot Lakes, MN
• Providers in Pequot Lakes, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.