Gundersen Clinic, LTD.
Organization Active NPI Optometrist · Prairie Du Chien, WI
NPI 1023064078 · NPPES record last updated Aug 6, 2021
Key facts
- NPI
- 1023064078
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- GUNDERSEN CLINIC, LTD.
- Practice address
- 118 S Marquette Rd
Prairie Du Chien, WI 53821-1640 - Phone
- (608) 782-7300
- NPI assigned
- May 25, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- GUNDERSEN CLINIC LTD
Authorized official
- Name
- Kari B Adank
- Title
- Cco
- Phone
- (608) 775-8025
Other NPIs on the same Medicare enrollment 19
Corporate family (same tax ID) 13
Practitioners 1
-
Mary E Nelson, MD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Gundersen Clinic LTD |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000139 | WI | Part B Supplier - Clinic/Group Practice | 9638082779 |
Receives reassigned benefits from 1,052 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
| O20100930060164 | WI | DME Supplier - Physician - Optometrist |
9638082779 | Practice locations: Prairie Du Chien, WI |
National Provider Directory
- Tax ID family
- La Liberte-Gundersen VI
- Part of
- La Liberte-Gundersen VI
Locations
213 W Blackhawk Ave
Pr du Chien, WI 53821
Phone (608) 326-6453
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Dental Clinic/Center | 261QD0000X | |||
| Oral and Maxillofacial Surgery Clinic/Center | 261QS0112X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
118 S Marquette Rd
Prairie Du Chien, WI 53821-1640
Mailing address
1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300
Other names
- Gundersen Eye Clinic and Dental Specialties Prairie du Chien
Other providers in Prairie Du Chien, WI
- Great River Community Medical Clinic SC
- Erin M Greenya
- Ann L Grunwald
- Mark A Grunwald
- Gundersen Clinic LTD
- Gundersen Clinic, LTD.
- Gundersen Clinic, LTD.
- Gundersen Lutheran Medical Center Inc
- Kaitlin Halverson
- Kelsey Ann Hamann
All providers in Prairie Du Chien, WI · Optometrist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.