Amy L Petkus, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003794 Issued in IN

Practice address

2106 Calumet Ave
Valparaiso, IN 46383-2708

Phone

(219) 464-8200

Fax

(219) 531-6804

NPI assigned

Jun 11, 2013

Last updated

Apr 12, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amy L Moran Former name

Medicare fee-for-service enrollment

Enrolled in IN

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

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myeyedr Optometry of Indiana LLCGroup PAC ID 5496091316, 82 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.

• Myeyedr Optometry of Indiana, LLC

  dba MyEyeDr.

  • Optometrist
  • Lebanon, IN
  • NPI 1083100424
  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Indiana, LLC

  • Optometrist
  • Munster, IN
  • NPI 1922974526
  NPD
• Myeyedr Optometry of Indiana, LLC

  dba MyEyeDr.

  • Optometrist
  • Valparaiso, IN
  • NPI 1942796362
  NPD

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1750729869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 CALUMET AVE",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832708",
            "telephone_number": "219-464-8200",
            "fax_number": "219-531-6804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETKUS",
        "first_name": "AMY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-11",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "MORAN",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Pessmeg Rossi, LMHC
• Donna P Peters, MSW, LSW
• Lita Peters
• Aaliyah Peterson
• Ashleigh Peterson, DNP, FNP-BC
• Gina Eich Peyton, MS, OTR/L
• Satish Dolly Phadke, PT
• Winna Pham, DDS
• Pharma - Card Inc (Pharma Card Valparaiso North)
• Anna Philipose

• Optometrist in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.