NPIMap

Individual provider Active NPI

Vani Pergadia, O.D.

  • Optometrist
  • Brentwood, MO
National Provider Identifier
1609017607
Registry record updated May 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2002030096 Issued in MO
Practice address
1 Brentwood Promenade CT
Brentwood, MO 63144-1428
Phone
(314) 961-7552
NPI assigned
Mar 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2002030096 MO Primary

Addresses

Primary practice location

1 Brentwood Promenade CT
Brentwood, MO 63144-1428

Mailing address

1 Brentwood Promenade CT
Brentwood, MO 63144-1428
Phone (314) 961-7552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2002030096MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Luxottica of America Inc Past Accepting new patients
Luxottica Retail North America Inc Optometrist Past Accepting new patients
Pearle Vision Inc Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274659200000",
    "number": "1609017607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BRENTWOOD PROMENADE CT",
            "city": "BRENTWOOD",
            "state": "MO",
            "postal_code": "631441428",
            "telephone_number": "314-961-7552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BRENTWOOD PROMENADE CT",
            "city": "BRENTWOOD",
            "state": "MO",
            "postal_code": "631441428",
            "telephone_number": "314-961-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERGADIA",
        "first_name": "VANI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-20",
        "last_updated": "2010-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2002030096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2010; 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.