Peter Lloyd Vatnsdal, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3286 Issued in MN

Practice address

306 Main Ave N
Roseau, MN 56751-1820

Phone

(218) 463-2020

NPI assigned

Jun 6, 2012

Last updated

Jun 6, 2012By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Indiana University - School of Optometry, 2012

Medicare assignment

May accept Medicare assignment

Group practices

Roseau Warroad Eye Clinic PAGroup PAC ID 3577784404, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Roseau Warroad Eye Clinic PA

  dba Warroad eye Clinic

  • Optometrist
  • Warroad, MN
  • NPI 1669875514
  Medicare reassignment Care Compare group NPD
• Roseau Warroad Eye Clinic PA

  dba Roseau Eye Clinic

  • Optometrist
  • Roseau, MN
  • NPI 1396148839
  NPD
• Roseau/Warroad Eye Clinic, P.a.

  • Optometrist
  • Warroad, MN
  • NPI 1861562340
  NPD (past)

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338940800000",
    "number": "1639430689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 OAK CREST BLVD",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567512300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 MAIN AVE N",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511820",
            "telephone_number": "218-463-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VATNSDAL",
        "first_name": "PETER",
        "middle_name": "LLOYD",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-06",
        "last_updated": "2012-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clyde Richard Stephens, PAC
• Nghi Trinh-Pham, D.D.S.
• Rekiyatu Lawal Ugboajah, MD
• Bryon D Vandewege, MD
• Lorris Galen Vatnsdal II
• Amber L Wibbels, DPM
• Kaci Laine Wilmer, MOTR/L
• Kenneth James Wright, MD
• Angela Yee, O.D.

• Optometrist in Roseau, MN
• Providers in Roseau, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; 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.