Allison Lynn Wiedemann, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3164 Issued in MN

Practice address

570 Northtown Dr NE
Blaine, MN 55434-1043

Phone

(763) 784-4081

Fax

(866) 822-2088

NPI assigned

Sep 28, 2006

Last updated

Aug 2, 2013By the provider in NPPES

Sex

Female

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375401600000",
    "number": "1770674160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 NORTHTOWN DR NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554341043",
            "telephone_number": "763-784-4081",
            "fax_number": "866-822-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 NORTHTOWN DR NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554341043",
            "telephone_number": "763-784-4081",
            "fax_number": "866-822-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEMANN",
        "first_name": "ALLISON",
        "middle_name": "LYNN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2013-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002322",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OPT002322",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN OPTOMETRY LICENSE",
            "identifier": "3164",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Werner, MA, LP, RPT-S, SEP
• Melissa Wetterlund, MA, LP, LMFT
• Emmanuel Wheagar II, PHARMD
• Amy Moran Wheelecor, PSYD, LP
• Lisa Marie Wicklund, LMT
• April Kay Williamson, LMFT
• Joseph Charles Wilson, DPT
• Windels Health Services
• Rebekah Jean Windschitl, MA, LPCC
• Joseph William Winegar, DDS

• Optometrist in Blaine, MN
• Providers in Blaine, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.