Dennis Raymond Soderberg, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1396 Issued in WI

Practice address

1620 10TH Ave
Baldwin, WI 54002-9033

Phone

(715) 684-3310

Fax

(715) 684-4560

NPI assigned

Apr 20, 2006

Last updated

Jul 9, 2007By 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 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Soderberg Eye Care Center

  • Optometrist
  • New Richmond, WI
  • NPI 1346344678
  NPD (past) Authorized official
• Soderberg Eye Care Center SC

  • Optometrist
  • Baldwin, WI
  • NPI 1548371966
  Authorized official Same address or phone

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1649235524",
    "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": {
        "last_name": "SODERBERG",
        "first_name": "DENNIS",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1396",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1549",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "774002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22-12358",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLAIMS MANAGEMENT",
            "identifier": "391170106044",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "92530S0",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "391170106028",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPCARE",
            "identifier": "391170106036",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38411800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "795000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clint G Semrau, DO
• Monica Shafer
• Jennifer Shaver, CNP
• Kaitlyn Sloan, APNP
• Soderberg Eye Care Center SC
• Elaine Marie Sorensen, L..P.N.
• St Croix Valley Shared Services
• St. Croix Orthopaedics, P.a.
• St. Croix Valley Shared Services, Inc. (ADORAY Hospice)
• St. Croix Valley Shared Services, Inc. (Adoray Home Health and 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 Jul 9, 2007; 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.