Ricky Lee Weidow, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002670A/B Issued in IN

Practice address

201 W Wayne St
Lagrange, IN 46761-1850

Phone

(260) 463-3421

Fax

(260) 463-7347

NPI assigned

Jul 12, 2005

Last updated

Feb 14, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Indiana Eye and Laser Center PCGroup PAC ID 5193701340, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northwest Indiana Eye & Laser Center PC

  • Ophthalmology Physician
  • Valparaiso, IN
  • NPI 1336212117

  Optometrist

  Medicare reassignment Care Compare group NPD
• Renaissance Ocular Disease and Trauma Foundation, Inc.

  dba Evergreen Eye Clinic

  • Optometrist
  • Lagrange, IN
  • NPI 1174740682
  Authorized official Same address or phone
• Vision Surgery and Laser Center of Indiana LLC

  • Ambulatory Surgical Clinic/Center
  • Valparaiso, IN
  • NPI 1336806967
  NPD (past)

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266105600000",
    "number": "1639177793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W WAYNE ST",
            "address_2": "PO BOX 150",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467611850",
            "telephone_number": "260-463-3421",
            "fax_number": "260-463-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W WAYNE ST",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467611850",
            "telephone_number": "260-463-3421",
            "fax_number": "260-463-7347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDOW",
        "first_name": "RICKY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2010-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002670A/B",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IN",
            "license": "18002670A/B",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "IN",
            "license": "18002670A/B",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS NWIELC KNOX",
            "identifier": "000000635212",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200097680C",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN LAGRANGE",
            "identifier": "2604633421",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN TOPEKA",
            "identifier": "2605932505",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS LAGRANGE",
            "identifier": "000000257711",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200097680D",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS TOPEKA",
            "identifier": "000000257712",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RENAISSANCE OCULAR DISEASE AND TRAUMA FOUNDATION TYPE 2 GROUP NPI",
            "identifier": "1174740682",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN SOUTH BEND",
            "identifier": "5742334109",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200097680E",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vistula Park Preschool, Inc. (LaGrange County Healthy Families)
• Waggoner & Waggoner DC LLC
• Chase Daniel Waggoner, D.C.
• Oliver Yuchong Wang, DDS
• Michelle Elaine Watson, COTA
• Blake Weimer, NP
• Kathleen Westling, LCSW
• Deneise Weyhmiller, MSW
• Ruth Ann Wilson, NP
• Arlene R Word-White, NP-C

• Optometrist in Lagrange, IN
• Providers in Lagrange, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2010; 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.