DR. SUSAN N DIEDERICH (NPI# 1750318580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750318580 |
| Entity Type | Individual |
| Full Name | DR. SUSAN N DIEDERICH |
| Other Name | SUSAN N BRAHM |
| Credential | O.D. |
| Practice Address |
1260 N Port Washington Rd Grafton WI 53024-9315 |
| Mailing Address |
16800 West Cleveland Ave New Berlin WI 53151-3533 |
| Practice Telephone | 2625460234 |
| Mailing Telephone | 2624322005 |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2013-02-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 2981-035 | WI | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| EYEMED VISION NO. | WI2981 | 01 | |
| WI | DEA | MB1157002 | 01 |
| WI | 38624700 | 05 |
| Street Address |
1260 N PORT WASHINGTON RD |
| City | GRAFTON |
| State | WI |
| Zip Code | 53024-9315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942348131 | Wisconsin Vision, Inc | Technician/Technologist | 1260 N Port Washington Rd, Grafton, WI 53024-9315 | 2007-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739135 | Kathy Anne Herzog | Counselor | 101 Falls Rd Suite 210, Grafton, WI 53024 | 2018-02-06 |
| 1992215867 | Caroline Marie Brandt | Nurse Practitioner | 975 Port Washington Rd Ste 310, Grafton, WI 53024 | 2017-10-05 |
| 1124569181 | Quirt Family Dentistry, Sc | Dentist | 1580 Port Washington Road, Grafton, WI 53024 | 2017-03-10 |
| 1639626260 | Jennifer Pogodzinski | Physical Therapist | 975 N. Port Washington Avenue, Grafton, WI 53024 | 2016-09-01 |
| 1750790119 | Amanda K Olejniczak | Dentist | 1505 Wisconsin Ave, Ste 130, Grafton, WI 53024 | 2014-08-10 |
| 1992053680 | Liliya Lakshtanov | Registered Nurse | 910 E. Paradise Dr., West Bend, WI 53024 | 2012-08-28 |
| 1467708446 | Trevor Holwell | Pharmacist | 1600 N Port Washington Rd, Grafton, WI 53024 | 2012-07-27 |
| 1770838120 | Brian A. Vetterkind | Physical Therapist | 2225 Wisconsin Ave Ste 100, Grafton, WI 53024 | 2012-07-20 |
| 1366774689 | Tracy Lynn Doro-krueger | Counselor | 1814 Arapaho Court, Grafton, WI 53024 | 2010-02-11 |
| 1659507754 | Karen Marie Geschke | Physical Therapist | 2020 Cheyenne Ct., Grafton, WI 53024 | 2009-06-03 |
| Find all providers in zip 53024 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114369063 | Tristan Robert Begotka | Optometrist | 1210 12th Ave, Grafton, WI 53024-1924 | 2013-07-19 |
| 1518178342 | Nina Pham Christensen | Optometrist | 950 N Port Washington Rd, Grafton, WI 53024-9201 | 2007-05-24 |
| 1841310547 | Michelle H Lewis | Optometrist | 950 Port Washington Rd, Grafton, WI 53024-9201 | 2007-03-29 |
| 1437294832 | Kent Byron Mcquain | Optometrist | 5220 George Washington Mem Hwy, Grafton, VA 23692-2759 | 2007-02-21 |
| 1043226947 | Thomas Dean Freed | Optometrist | 1106 Washington St, Grafton, WI 53024-1916 | 2006-07-31 |
| 1811949886 | Anthony Robert Molinari | Optometrist | 1 Hollywood Drive, Grafton, MA 01536 | 2006-05-17 |
| 1013990241 | Sherry Lee Knotts | Optometrist | 216 Lincoln St, Grafton, WV 26354-1442 | 2005-11-22 |
| 1497747984 | Michelle Kaye Carter | Optometrist | 415 Hill Ave, Grafton, ND 58237-1001 | 2005-08-19 |
| 1558845081 | Matthew Francis Byers | Optometrist | 1771 Wisconsin Ave, Grafton, WI 53024-2437 | 2018-09-20 |
| 1356622898 | Prn Eye Associates LLC | Optometrist | 950 Port Washington Rd, Grafton, WI 53024-9201 | 2011-08-29 |
| Find all providers in GRAFTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.