Andrea C So, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

14890 Issued in CA

Practice address

1025 Regent St
Madison, WI 53715-1248

Phone

(608) 282-2000

Fax

(608) 282-2172

NPI assigned

Jul 23, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Marshall B Ketchum UniversityGroup PAC ID 9739075177, 56 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Marshall B. Ketchum University

  • Optometrist
  • Anaheim, CA
  • NPI 1720101876
  Medicare reassignment Care Compare group NPD
• Marshall B. Ketchum University

  • Multi-Specialty Clinic/Center
  • Anaheim, CA
  • NPI 1174037493
  NPD

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1831531557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 REGENT ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151248",
            "telephone_number": "608-282-2000",
            "fax_number": "608-282-2172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 REGENT ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151248",
            "telephone_number": "608-282-2000",
            "fax_number": "608-282-2172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SO",
        "first_name": "ANDREA",
        "middle_name": "C",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-23",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14890",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3316-035",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831531557",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Rose Snyder
• Joan Lorraine Snyder, MSSW
• Michael D. Snyder, MD
• Shelby Bernice Snyder
• Trenton Snyder, MD
• Bophia So
• Soar Case Management Services, Inc.
• Gregory J Sobczak, DDS
• Janelle Sobecki, MD
• Sober Living in Madison, LLC

• Optometrist in Madison, WI
• Providers in Madison, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.