NPIMap

Organization Active NPI

Gundersen Clinic, LTD.

Doing business as Gundersen Eye Clinic and Dental Specialties Prairie du Chien

  • Optometrist
  • Prairie Du Chien, WI
National Provider Identifier
1023064078
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GUNDERSEN CLINIC, LTD.
Doing business as
Gundersen Eye Clinic and Dental Specialties Prairie du Chien
Practice address
118 S Marquette Rd
Prairie Du Chien, WI 53821-1640
Phone
(608) 782-7300
NPI assigned
May 25, 2006
Last updated
Aug 6, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
GUNDERSEN CLINIC LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Authorized official

Name
Kari B Adank
Title
Cco
Phone
(608) 775-8025

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X
Durable Medical Equipment & Medical Supplies 332B00000X
Optometrist 152W00000X Primary

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 1

  • Gundersen Eye Clinic and Dental Specialties Prairie du Chien Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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 - OptometristDME Supplier - Optician 9638082779 Practice locations: Prairie Du Chien, WI

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Gundersen Clinic LTD118 S Marquette Rd, Prairie Du Chien, WI 53821-1640(608) 326-6453 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Gunderson Decorah Podiatry53 organizations share this tax ID, including this one
Part of
Gunderson Decorah Podiatry

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

213 W Blackhawk Ave
Pr du Chien, WI 53821
Phone (608) 326-6453

213 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-6453

Practitioners & affiliated clinicians

Practitioners 1

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": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1023064078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 S MARQUETTE RD",
            "city": "PRAIRIE DU CHIEN",
            "state": "WI",
            "postal_code": "538211640",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUNDERSEN CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN CLINIC LTD",
        "enumeration_date": "2006-05-25",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "ADANK",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "608-775-8025"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gundersen Eye Clinic and Dental Specialties Prairie du Chien",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gundersen Eye Clinic and Dental Specialties Prairie du Chien",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prairie Du Chien, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.