Nathan Henry Wiederholt, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

656 Issued in SD

Practice address

322 Mount Rushmore Rd
Suite 120
Custer, SD 57730-1936

Phone

(605) 673-2716

Fax

(605) 673-2017

NPI assigned

Jul 18, 2008

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 1

Medicare fee-for-service enrollment

Enrolled in SD

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

Pacific University - College of Optometry, 2008

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

Locations

Interoperability endpoints

• Direct secure messaging: nwiederholt@premierfamilyeyecare.eyeclinicdirect.net

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.

• Premier Family Eye Care, PC

  • Optometrist
  • Custer, SD
  • NPI 1699919852
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276646400000",
    "number": "1447414461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 MOUNT RUSHMORE RD",
            "address_2": "SUITE 120",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301936",
            "telephone_number": "605-673-2716",
            "fax_number": "605-673-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 MOUNT RUSHMORE RD",
            "address_2": "SUITE 120",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301936",
            "telephone_number": "605-673-2716",
            "fax_number": "605-673-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDERHOLT",
        "first_name": "NATHAN",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-18",
        "last_updated": "2010-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203883",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connor Eugene Weisser, DO
• Allen Andrew Wellman, MD
• Christopher James Wenger, M.D.
• Danielle Wheeler, DPT
• Dennis R. Wicks, M.D.
• Vernon Wong, OD
• Word of Mouth, Inc
• John Robert Zent, DDS
• Jennifer N Zettl, DNP,FNP-C, CNP

• Optometrist in Custer, SD
• Providers in Custer, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; 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.