Eric E Miedema, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT9947TPA Issued in CA

Practice address

1700 McHenry Avenue
Suite 77
Modesto, CA 95350-4318

Phone

(209) 524-4626

Fax

(209) 524-1046

NPI assigned

Nov 17, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

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

Illinois College of Optometry at Chicago, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stanislaus Vision Associates Optometric Group IncGroup PAC ID 9133296460, 2 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Stanislaus Vision Associates Optometric Group Inc

  • Optometrist
  • Modesto, CA
  • NPI 1457425852
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198713600000",
    "number": "1336213735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 MCHENRY AVENUE",
            "address_2": "SUITE 77",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504318",
            "telephone_number": "209-524-4626",
            "fax_number": "209-524-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MCHENRY AVENUE",
            "address_2": "SUITE 77",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504318",
            "telephone_number": "209-524-4626",
            "fax_number": "209-524-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIEDEMA",
        "first_name": "ERIC",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2007-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT9947TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410020358",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0099470",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "94217822195350B2",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam Michnowski
• Emily Mickschl
• Sarah Mickschl
• Maria Regina Lardizabal Mico
• Mid Valley Health Services Long Term Care Inc
• Krystle Marie Miguens
• Kelly Jo Mikelson
• Lauren E Miklose
• Kristi Lynn Miklusicak, M.A., B.I.C.M.
• Ahryanna Miles

• Optometrist in Modesto, CA
• Providers in Modesto, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; 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.