Jerry R. Pederson, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

724 Issued in CO

Legal business name

JERRY R. PEDERSON, O.D.

Practice address

6650 S Vine St
Suite 160
Centennial, CO 80121-2735

Phone

(303) 798-5533

Fax

(303) 798-2800

NPI assigned

Feb 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Ray Pederson, O.D.

Title

Owner

Phone

(303) 798-5533

Specialties & licenses 1

Addresses

Tax ID family

Jerry R Pederson OD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southglenn Eyecare, PC

  • Optometrist
  • Centennial, CO
  • NPI 1114167947
  NPD tax ID

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1811031859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6650 S VINE ST",
            "address_2": "SUITE 160",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801212735",
            "telephone_number": "303-798-5533",
            "fax_number": "303-798-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 S VINE ST",
            "address_2": "SUITE 160",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801212735",
            "telephone_number": "303-798-5533",
            "fax_number": "303-798-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY R. PEDERSON, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-798-5533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CO",
            "license": "724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Jenniges, OTR/L
• Jenny Nickerson (Mountain State Medical Massage)
• Hannah Jensen
• Dawn Marie Jenson, MSPT
• Jeremyj. Zeigler DMD, PLLC (New Day Dentistry)
• Jerry R. Pederson, O.D., P.C. (Southglenn EyeCare, PC)
• Jessica Kruckeberg (Areas of Growth LLC)
• Joshua Jewell
• Jill Tullman & Associates, LLC
• Kara Sunshine Jindrich, MD

• Corneal and Contact Management Optometrist in Centennial, CO
• Providers in Centennial, CO by specialty
• Corneal and Contact Management Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.