Dianna L Bordewick, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

41090 Issued in WI

Practice address

2253 W Mason St Ste 100
Green Bay, WI 54303-4706

Phone

(920) 327-7000

Fax

(920) 327-7005

NPI assigned

Jun 19, 2006

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 identifiers 3

Other names 1

• Dianna L Myers Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dbordewick@eugeneeyecare.intellechartdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eugene Eye Care Associates, PC

  • Ophthalmology Physician
  • Eugene, OR
  • NPI 1457553976
  Medicare reassignment NPD
• Baycare Clinic LLP

  • Durable Medical Equipment & Medical Supplies
  • Green Bay, WI
  • NPI 1851336242

  Ophthalmology

  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1790720100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST STE 100",
            "address_2": "PO BOX 13097",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543073097",
            "telephone_number": "920-327-7000",
            "fax_number": "920-327-7005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 W MASON ST STE 100",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034706",
            "telephone_number": "920-327-7000",
            "fax_number": "920-327-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEWICK",
        "first_name": "DIANNA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": "41090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32562600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "180043984",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104390165",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANNA",
            "last_name": "MYERS",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edward J Bongiorno, DO
• Andrea Bonnin
• Julie Bonnin, MD
• April C Borchardt, DPM
• Denise Borchardt, PT
• Bradford Paul Bordini, LCSW
• Carolyn Margaret Bores, DDS
• Cori E Borg, APNP
• Jeanne Louise Borgen, CRNA
• Jesse Jon Borman, MD

• Ophthalmology Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Ophthalmology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; 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.