1 Vision S.C.
Organization Active NPI Optometrist · Shawano, WI
NPI 1033197397 · NPPES record last updated May 17, 2022
Key facts
- NPI
- 1033197397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2324 (WI)
- Legal business name
- 1 VISION S.C.
- Practice address
- 150A County Rd B
Shawano, WI 54166-7072 - Phone
- (715) 526-3163
- Fax
- (715) 526-4019
- NPI assigned
- Jan 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Thomas G Peterson, O.D.
- Title
- O.D. - President
- Phone
- (715) 526-3163
Practitioners 8
-
Thomas G Peterson, O.D.
-
Jacob Wittman, OD
-
Michelle Marie Mueller, O.D.
-
Nelson Howard Hassell, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| 1 Vision S.C. |
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 |
|---|---|---|---|---|
| O20100628000717 | WI | Part B Supplier - Clinic/Group Practice | 4880725308 |
Receives reassigned benefits from 6 practitioners Practice locations: Antigo, WI; Clintonville, WI; Shawano, WI |
| O20100930046515 | WI | DME Supplier - Physician - Optometrist | 4880725308 | Practice locations: Shawano, WI |
National Provider Directory
Locations
810 5th Ave
Antigo, WI 54409
Phone (715) 623-3620
150 County Road B
#A
Shawano, WI 54166
150A County Road B
Shawano, WI 54166
Phone (715) 526-3163
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2324 | WI | Yes |
Addresses
Primary practice location
150A County Rd B
Shawano, WI 54166-7072
Mailing address
PO Box 513
Shawano, WI 54166-0513
Phone (715) 526-3163
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410033786 | Other | WI | RAILROAD MEDICARE |
| 38578000 | Medicaid | WI |
Other providers in Shawano, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2022. 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.