Dr Ricky Lee Weidow, OD is a medicare enrolled "Optometrist" provider in Lagrange, Indiana. He went to Southern College Of Optometry and graduated in 1993 and has 31 years of diverse experience with area of expertise as Optometry. He is a member of the group practice Northwest Indiana Eye And Laser Center Pc and his current practice location is
201 W Wayne St, Lagrange, Indiana. You can reach out to his office (for appointments etc.) via phone at
(260) 463-3421.
Dr Ricky Lee Weidow is licensed to practice in Indiana (license number 18002670A/B) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1639177793.
Healthcare Provider's Profile
| Full Name | Dr Ricky Lee Weidow |
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| Gender | Male |
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| Speciality | Optometry |
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| Experience | 31 Years |
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| Location | 201 W Wayne St, Lagrange, Indiana |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Ricky Lee Weidow attended and graduated from Southern College Of Optometry in 1993
NPI Data:
- NPI Number: 1639177793
- Provider Enumeration Date: 07/12/2005
- Last Update Date: 02/14/2010
Medicare PECOS Information:
- PECOS PAC ID: 8921022328
- Enrollment ID: I20091223000119
Medical Identifiers
Medical identifiers for Dr Ricky Lee Weidow such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1639177793 | NPI | - | NPPES |
| 000000635212 | Other | IN | ANTHEM BC/BS NWIELC KNOX |
| 2604633421 | Other | IN | VISION SERVICE PLAN LAGRANGE |
| 5742334109 | Other | IN | VISION SERVICE PLAN SOUTH BEND |
| 2605932505 | Other | IN | VISION SERVICE PLAN TOPEKA |
| 000000257711 | Other | IN | ANTHEM BC/BS LAGRANGE |
| 000000257712 | Other | IN | ANTHEM BC/BS TOPEKA |
| 1174740682 | Other | IN | RENAISSANCE OCULAR DISEASE AND TRAUMA FOUNDATION TYPE 2 GROUP NPI |
| 200097680C | Medicaid | IN | |
| 200097680E | Medicaid | IN | |
| 200097680D | Medicaid | IN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | 18002670A/B (Indiana) | Primary |
| 152WC0802X | Optometrist - Corneal And Contact Management | 18002670A/B (Indiana) | Secondary |
| 152WP0200X | Optometrist - Pediatrics | 18002670A/B (Indiana) | Secondary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Northwest Indiana Eye And Laser Center Pc | 5193701340 | 6 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Ricky Lee Weidow allows following entities to bill medicare on his behalf.
| Provider Name | Northwest Indiana Eye & Laser Center Pc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1336212117
PECOS PAC ID: 5193701340
Enrollment ID: O20060111000618 |
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| Provider Name | Renaissance Ocular Disease And Trauma Foundation Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1174740682
PECOS PAC ID: 7012057086
Enrollment ID: O20091223000144 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Ricky Lee Weidow is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Ricky Lee Weidow, OD
201 W Wayne St, Po Box 150,
Lagrange, IN 46761-1850
Ph: (260) 463-3421 | Dr Ricky Lee Weidow, OD
201 W Wayne St,
Lagrange, IN 46761-1850
Ph: (260) 463-3421 |
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