Douglas Stephen Wiersma, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

6168 Issued in OH

Practice address

1261 W Royalton Rd
Broadview Heights, OH 44147-2407

Phone

(440) 526-7070

NPI assigned

Jul 16, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1518212539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29885 SEQUOIA TRL",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441455153",
            "telephone_number": "440-376-1690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 W ROYALTON RD",
            "city": "BROADVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "441472407",
            "telephone_number": "440-526-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSMA",
        "first_name": "DOUGLAS",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-16",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "6168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Broadview Heights, OH
• Providers in Broadview Heights, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; 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.