Soderberg Eye Care Center SC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1396 Issued in WI

Legal business name

SODERBERG EYE CARE CENTER SC

Practice address

1620 10TH Ave
Baldwin, WI 54002-9033

Phone

(715) 684-3310

Fax

(715) 684-4560

NPI assigned

Aug 31, 2006

Last updated

May 14, 2013By the provider in NPPES

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.NPI 1649235524

Title

President

Phone

(715) 684-3310

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Dennis R. Soderberg O. D. Other name

Locations

Practitioners 1

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.

• Dennis Raymond Soderberg, O.D.

  • Optometrist
  • Baldwin, WI
  • NPI 1649235524
  Authorized official Same address or phone

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1548371966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 10TH AVE",
            "city": "BALDWIN",
            "state": "WI",
            "postal_code": "540029033",
            "telephone_number": "715-684-3310",
            "fax_number": "715-684-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 10TH AVE",
            "city": "BALDWIN",
            "state": "WI",
            "postal_code": "540029033",
            "telephone_number": "715-684-3310",
            "fax_number": "715-684-4560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SODERBERG EYE CARE CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-05-14",
        "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": "715-684-3310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O. D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WEA",
            "identifier": "130000518",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38411800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-12358",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "92530S0",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "234200600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dennis R. Soderberg O. D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• David E Scott, DDS
• Clint G Semrau, DO
• Monica Shafer
• Jennifer Shaver, CNP
• Kaitlyn Sloan, APNP
• Dennis Raymond Soderberg, O.D.
• Elaine Marie Sorensen, L..P.N.
• St Croix Valley Shared Services
• St. Croix Orthopaedics, P.a.
• St. Croix Valley Shared Services, Inc. (ADORAY Hospice)

• Optometrist in Baldwin, WI
• Providers in Baldwin, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; 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.