Eric Paul Pedersen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2745 Issued in WI

Practice address

120 Martin Dr
Fredonia, WI 53021-9455

Phone

(262) 692-9000

Fax

(262) 692-2797

NPI assigned

Oct 13, 2005

Last updated

Feb 22, 2013By the provider in NPPES

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 names 1

• Dr. Eric Paul Pedersen Sr. Professional name

Medicare fee-for-service enrollment

Enrolled in WI

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

Indiana University - School of Optometry, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Great Lakes Family Vision SC

  • Eyewear Supplier
  • Saukville, WI
  • NPI 1437485125
  Medicare reassignment NPD
• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • Kenosha, WI
  • NPI 1164992996
  Medicare reassignment NPD
• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • New Berlin, WI
  • NPI 1659833218
  NPD
• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • West Allis, WI
  • NPI 1710632864
  NPD

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361491200000",
    "number": "1992793806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MARTIN DR",
            "city": "FREDONIA",
            "state": "WI",
            "postal_code": "530219455",
            "telephone_number": "262-692-9000",
            "fax_number": "262-692-2797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MARTIN DR",
            "city": "FREDONIA",
            "state": "WI",
            "postal_code": "530219455",
            "telephone_number": "262-692-9000",
            "fax_number": "262-692-2797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "ERIC",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2013-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIC",
            "last_name": "PEDERSEN",
            "middle_name": "PAUL",
            "prefix": "DR.",
            "suffix": "SR.",
            "credential": "OD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Allison Johnson
• Melissa J Knous, OD
• Myeyedr Optometry of Wisconsin, LLC (MyEyeDr.)
• Michelle M Nave, O.D.
• Northern Ozaukee School District
• Poth Family Dental, S.C.
• John Everett Poth, DDS
• Karla Marie Poth, DDS
• Pro-Active Physical Therapy, S.C.
• SE Professionals, S.C. (Premier Vision)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; 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.