Active NPI
Mikel Robert Weideman, O.D.
- Optometrist
- Lander, WY
National Provider Identifier
1952464604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 134T
- Practice address
- 556 Main St
Lander, WY 82520-3032 - Phone
- (307) 332-2020
- NPI assigned
- Dec 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 134T | WY | Primary |
Addresses
Primary practice location
556 Main St
Lander, WY 82520-3032
Mailing address
556 Main St
Lander, WY 82520-3032
Phone (307) 332-2020
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 301173 | Other | BCBS | |
| 106723100 | Medicaid | WY | |
| 830260533 | Other | VISION SERVICE PLAN |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588809600000",
"number": "1952464604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "556 MAIN ST",
"city": "LANDER",
"state": "WY",
"postal_code": "825203032",
"telephone_number": "307-332-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "556 MAIN ST",
"city": "LANDER",
"state": "WY",
"postal_code": "825203032",
"telephone_number": "307-332-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEIDEMAN",
"first_name": "MIKEL",
"middle_name": "ROBERT",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-17",
"last_updated": "2020-05-07",
"certification_date": "2020-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WY",
"license": "134T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "301173",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106723100",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VISION SERVICE PLAN",
"identifier": "830260533",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lander, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.