NPIMap

Organization Active NPI

Wesley M Andersen OD PA

Doing business as Springdale Vision Clinic

  • Optometrist
  • Springdale, AR
National Provider Identifier
1447307327
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2561 Issued in AR
Legal business name
WESLEY M ANDERSEN OD PA
Doing business as
Springdale Vision Clinic
Practice address
3291 S Thompson St Ste C101
Springdale, AR 72764-7343
Phone
(479) 751-3937
Fax
(479) 751-7518
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Wesley M Andersen, O.D.NPI 1255382438
Title
Owner
Phone
(479) 751-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2561 AR Primary

Addresses

Primary practice location

3291 S Thompson St Ste C101
Springdale, AR 72764-7343

Mailing address

3291 S Thompson C 101
Springdale, AR 72764
Phone (479) 751-3937

Other names 1

  • Springdale Vision Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070312000609 AR Part B Supplier - Clinic/Group Practice 0345343331 Receives reassigned benefits from 1 practitioner
Practice locations: Springdale, AR

National Provider Directory

National Provider Directory

Locations

3291 S Thompson St
Ste C101
Springdale, AR 72764
Phone (479) 466-0466

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447307327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3291 S THOMPSON C 101",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "72764",
            "telephone_number": "479-751-3937",
            "fax_number": "479-751-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3291 S THOMPSON ST STE C101",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727647343",
            "telephone_number": "479-751-3937",
            "fax_number": "479-751-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESLEY M ANDERSEN OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-751-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Springdale Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springdale, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.