Premier Family Eye Care, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

656 Issued in SD

Legal business name

PREMIER FAMILY EYE CARE, PC

Practice address

322 Mount Rushmore Rd
Suite 120
Custer, SD 57730-1936

Phone

(605) 673-2716

Fax

(605) 673-2017

NPI assigned

Apr 30, 2009

Last updated

Jun 29, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nathan Wiederholt, O.D.NPI 1447414461

Title

Owner

Phone

(605) 673-2716

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nathan Henry Wiederholt, O.D.

  • Optometrist
  • Custer, SD
  • NPI 1447414461
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1699919852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 MOUNT RUSHMORE RD",
            "address_2": "SUITE 120",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301936",
            "telephone_number": "605-673-2716",
            "fax_number": "605-673-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 MOUNT RUSHMORE RD",
            "address_2": "SUITE 120",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301936",
            "telephone_number": "605-673-2716",
            "fax_number": "605-673-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY EYE CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-30",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "WIEDERHOLT",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-673-2716",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203883",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Nicole Peterson, LPC-MH
• Pamela Marie Peterson, RN
• Roni Petik, RPT
• Gypsy Petz
• Positive Directions Counseling, Inc
• Tiffany E Pullins, FNP
• Regional Health Network Inc (Custer Regional Hospital)
• Regional Health Network Inc (Custer Regional Hospital)
• Regional Health Network Inc (Regional Health Custer Hospital)
• Regional Health Network Inc (Custer Regional Clinic)

• Optometrist in Custer, SD
• Providers in Custer, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.