Individual provider Active NPI

Lara Pedretti, O.D.

  • Optometrist
  • Peoria, IL
National Provider Identifier
1750339628
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2670 Issued in WI
Practice address
7717 N Orange Prairie Rd
Peoria, IL 61615-9323
Phone
(309) 589-6800
Fax
(309) 589-6994
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2670 WI Primary
Optometrist 152W00000X 5517T TX

Addresses

Primary practice location

7717 N Orange Prairie Rd
Peoria, IL 61615-9323

Mailing address

7717 N Orange Prairie Rd
Peoria, IL 61615-9323
Phone (309) 589-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20130626000205 IL Order and Referring Only - OptometryPractitioner - Optometry 3678504438

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2670WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Danville Vamc PastSince Dec 12, 2021 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364774400000",
    "number": "1750339628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7717 N ORANGE PRAIRIE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159323",
            "telephone_number": "309-589-6800",
            "fax_number": "309-589-6994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7717 N ORANGE PRAIRIE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159323",
            "telephone_number": "309-589-6800",
            "fax_number": "309-589-6994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDRETTI",
        "first_name": "LARA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2013-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2670",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5517T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.