Soderberg Eye Care Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

1396 Issued in WI

Legal business name

SODERBERG EYE CARE CENTER

Practice address

124 Oak Street
Glenwood City, WI 54013

Phone

(715) 265-7127

Fax

(715) 265-4238

NPI assigned

Sep 7, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Dennis Raymond Soderberg, O.D.

Title

President

Phone

(715) 265-7127

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dennis R. Soderberg O.D. Other name

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236124800000",
    "number": "1356444798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "GLENWOOD CITY",
            "state": "WI",
            "postal_code": "540130097",
            "telephone_number": "715-265-7127",
            "fax_number": "715-265-4238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 OAK STREET",
            "city": "GLENWOOD CITY",
            "state": "WI",
            "postal_code": "54013",
            "telephone_number": "715-265-7127",
            "fax_number": "715-265-4238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SODERBERG EYE CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2009-03-04",
        "status": "A",
        "authorized_official_last_name": "SODERBERG",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-265-7127",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38501900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "92533SO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dennis R. Soderberg O.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• School District of Glenwood City
• Matthew Schouten
• Lea Schumacher, COTA
• Amber Schurman, OTR
• Kyle Shea
• Jennifer Anne Turner, RN
• Karen Wik
• Lucas Joseph Wolf, DC
• Jodi Rochelle Yadon

• Optometrist in Glenwood City, WI
• Providers in Glenwood City, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.