Lisa J. Vredevoogd, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301071619 Issued in MI

Practice address

205 W 29TH St
Suite 50
Holland, MI 49423-6973

Phone

(616) 796-9995

Fax

(616) 796-9998

NPI assigned

Jun 14, 2005

Last updated

Nov 11, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Lisa J. Tanttila Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of Colorado School of Medicine, Denver, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Eyes to See Pediatric Ophthalmology PLLC

  • Ophthalmology Physician
  • Zeeland, MI
  • NPI 1497086334
  Medicare reassignment NPD Authorized official
• Retina Specialists of Michigan PC

  • Retina Specialist (Ophthalmology) Physician
  • Grand Rapids, MI
  • NPI 1801048699
  NPD (past)
• Sight Eye Clinic, PC

  • Specialist
  • Zeeland, MI
  • NPI 1902839681

  Ophthalmology

  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447200000000",
    "number": "1487659868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W 29TH ST",
            "address_2": "SUITE 50",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494236973",
            "telephone_number": "616-796-9995",
            "fax_number": "616-796-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W 29TH ST",
            "address_2": "SUITE 50",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494236973",
            "telephone_number": "616-796-9995",
            "fax_number": "616-796-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VREDEVOOGD",
        "first_name": "LISA",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-14",
        "last_updated": "2015-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301071619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "TANTTILA",
            "middle_name": "J.",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lynelle Voght
• Karen Vonk, PHARMD
• Leah Vosburg-Achterhof
• Cleone Voss
• Jenna Voss, LLMSW, CAADC
• Luke Samuel Vriend-Dehart
• Erin Vriezema
• Lynn Vu
• Jamie Wadaga, AUD
• Tami Rae Wade, LBSW

• Ophthalmology Physician in Holland, MI
• Providers in Holland, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2015; 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.