Bert Pederzol, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3261 Issued in OH

Practice address

1650 S Union Ave
Alliance, OH 44601-4349

Phone

(330) 630-9699

NPI assigned

Dec 5, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1649338112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207170",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753202154",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 S UNION AVE",
            "city": "ALLIANCE",
            "state": "OH",
            "postal_code": "446014349",
            "telephone_number": "330-630-9699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1406 W Main St",
            "address_purpose": "LOCATION",
            "city": "Alliance",
            "state": "OH",
            "postal_code": "446012154",
            "country_code": "US",
            "telephone_number": "330-821-3045",
            "fax_number": "330-821-3072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERZOL",
        "first_name": "BERT",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0311219",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SH",
            "identifier": "000000131061",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Paulus, D.D.S.
• William D. Paulus, D.D.S.
• Mary L Pavlica, DO
• Rosemary Pavlich, CRNA
• Alexia Paxos
• Joseph M Pederzolli, OD
• Olivia Clare Peer, LSW
• Melissa Renee Peloso, LPN
• Paulina Pena Ochoa
• Laurie A Penix, MD

• Optometrist in Alliance, OH
• Providers in Alliance, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.