Michael Wade Jorgensen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1590-623T Issued in LA

Practice address

187 Burt Blvd
Ste a
Benton, LA 71006-4905

Phone

(318) 935-5080

Fax

(318) 935-5085

NPI assigned

Aug 6, 2010

Last updated

Nov 16, 2016By the provider in NPPES

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)

Not enrolled

State licenses

Practice roles

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.

• Dr. Michael Wade Jorgensen OD LLC

  • Optometrist
  • Benton, LA
  • NPI 1144677899
  NPD (past) Authorized official
• Vista Vision LLC

  • Eyewear Supplier
  • Benton, LA
  • NPI 1558718205
  NPD (past)

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

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479254400000",
    "number": "1558675157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "187 BURT BLVD",
            "address_2": "STE A",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710064905",
            "telephone_number": "318-935-5080",
            "fax_number": "318-935-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 BURT BLVD",
            "address_2": "STE A",
            "city": "BENTON",
            "state": "LA",
            "postal_code": "710064905",
            "telephone_number": "318-935-5080",
            "fax_number": "318-935-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "MICHAEL",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-06",
        "last_updated": "2016-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1590-623T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Hutchinson Ivey, MCD CCC-SLP
• Janet L Morehouse MD and Willis-Knighton Medical Center
• Shanna D. Johnson, MS,PT
• Dillon Parker Jones, D.O.
• Ryan Jones, PHARMD
• JRJ Supply LLC
• Just Health
• Just Health
• Marissa Lee Kees, LPC
• Dao B Kha, RPH

• Optometrist in Benton, LA
• Providers in Benton, LA by specialty
• Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; 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.