Wyman A Jorgenson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ND0336 Issued in ND

Practice address

315 11TH St N
Suite a
Wahpeton, ND 58075-4101

Phone

(701) 642-4090

Fax

(701) 642-9424

NPI assigned

Jul 14, 2006

Sex

Male

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 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213574400000",
    "number": "1851317846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 11TH ST N",
            "address_2": "SUITE A",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754101",
            "telephone_number": "701-642-4090",
            "fax_number": "701-642-9424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 11TH ST N",
            "address_2": "SUITE A",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754101",
            "telephone_number": "701-642-4090",
            "fax_number": "701-642-9424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSON",
        "first_name": "WYMAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "ND0336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "84M91JO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00215724",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60152",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ND",
            "identifier": "25387",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "624891045681",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2203146",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364223200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey S. Withuski & Paula Sabbe DDS
• Bonita J Jenzen, APRN,CNP
• Erin Nicole Jirak, PA-C
• Daniel William Johnson, DPT
• McKenzie Paige Johnson, OTA
• Judith K. Schmidt, D.D.S., P.C.
• Tamara Juneau
• Payton Nicole Kahler, LPN
• Matthew C Kammerer, DPM
• Amber Lynn Kania

• Optometrist in Wahpeton, ND
• Providers in Wahpeton, ND by specialty
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.