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Deactivated NPI 1114987005 Deactivated / Inactive NPI Male Practitioner

Dr. Roger Russell Knutson , OD

Optometrist • Greendale, WI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Roger Knutson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 24, 2006
NPI Deactivation Date January 28, 2022
Total Practice Duration ~16 Years of Practice (2006 – 2022)

Professional Overview & Biography Verified Profile Summary

Dr. Roger Knutson, OD was a registered Optometrist practicing in Greendale, WI. Throughout an active medical career spanning 16 years, Dr. Knutson provided care at the practice location at 5405 S 76TH ST until profile deactivation on 2022-01-28.

Practice Location & Contact Primary Location

Practice Address

5405 S 76th St

Greendale, WI 531291130

Telephone 4144213900
Fax 4144215870

Specialty Benchmarks & Practice Insights

Comparative analytics for Optometrist in Greendale, WI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 4.0 Yrs
State Avg: 21.0 Yrs
Regional Practice Density
9 Specialists

Practicing in Greendale, WI (1196 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Optometrist Primary Specialty

NUCC Taxonomy Code: 152W00000X

State License WI 1277035

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.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated January 28, 2022

Record deactivated on January 28, 2022

NPI Profile Active March 17, 2009

NPI status registered as active in NPPES database

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Updated Practice Location March 17, 2009

Registered at 5405 S 76TH ST, GREENDALE, WI 531291130 (Tel: 4144213900)

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Updated Business Mailing Address March 17, 2009

Registered at 5405 S 76TH ST, GREENDALE, WI 531291130 (Tel: 4144213900)

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Provider Name / Credentials Updated March 17, 2009

Recorded as ROGER KNUTSON, OD

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 17, 2009

Optometrist (License #1277035 in WI)

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Initial NPI Registration & Enumeration March 24, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114987005
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 24, 2006
Last Update: March 17, 2009
Deactivation Date: January 28, 2022

Mailing Address

5405 S 76th St

Greendale, WI 531291130

Phone: 4144213900

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.