NPIMap

Organization Active NPI

Eye Clinic of the Fox Valley SC

  • Optometrist
  • Oshkosh, WI
National Provider Identifier
1003925892
Registry record updated Jan 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TPA2317 Issued in WI
Legal business name
EYE CLINIC OF THE FOX VALLEY SC
Practice address
503 Doctors CT
Oshkosh, WI 54901-2025
Phone
(920) 236-3540
Fax
(920) 236-3558
NPI assigned
Aug 29, 2006
Last updated
Jan 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stephen S Dudley, MDNPI 1386753523
Title
President
Phone
(920) 236-3540

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TPA2317 WI Primary

Addresses

Primary practice location

503 Doctors CT
Oshkosh, WI 54901-2025

Mailing address

503 Doctors CT
Oshkosh, WI 54901-2025
Phone (920) 236-3540

Other identifiers 3

IdentifierTypeStateIssuer
CP7959OtherWIRAILROAD MEDICARE
CI7005OtherWIRAILRAOD MEDICARE FOR OD
32781900MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358294400000",
    "number": "1003925892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 DOCTORS CT",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549012025",
            "telephone_number": "920-236-3540",
            "fax_number": "920-236-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 DOCTORS CT",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549012025",
            "telephone_number": "920-236-3540",
            "fax_number": "920-236-3558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CLINIC OF THE FOX VALLEY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2013-01-16",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-236-3540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "TPA2317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP7959",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILRAOD MEDICARE FOR OD",
            "identifier": "CI7005",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32781900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.