Individual provider Active NPI

Stacy Kaye Neperud, O.D.

  • Optometrist
  • Beaver Dam, WI
National Provider Identifier
1861535809
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3069-035 Issued in WI
Practice address
207 N Spring St
Beaver Dam, WI 53916-2115
Phone
(920) 887-8831
Fax
(920) 887-8862
NPI assigned
Feb 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2640 MN
Optometrist 152W00000X 3069-035 WI Primary

Addresses

Primary practice location

207 N Spring St
Beaver Dam, WI 53916-2115

Mailing address

207 N Spring St
Beaver Dam, WI 53916-2115
Phone (920) 887-8831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2640MNMDOptometrist
3069-035WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Janet S White Optometrist Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: stacyneperud@beaverdameyecare.direct.eyemdemr.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265241600000",
    "number": "1861535809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 N SPRING ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162115",
            "telephone_number": "920-887-8831",
            "fax_number": "920-887-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 N SPRING ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162115",
            "telephone_number": "920-887-8831",
            "fax_number": "920-887-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEPERUD",
        "first_name": "STACY",
        "middle_name": "KAYE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2010-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2640",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3069-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; 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.