NPIMap

Organization Active NPI

Jan's Optical LLC

  • Optometrist
  • Waupun, WI
National Provider Identifier
1053759340
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3069-035 Issued in WI
Legal business name
JAN'S OPTICAL LLC
Practice address
223 E Main St
Waupun, WI 53963-2019
Phone
(920) 324-8608
Fax
(920) 324-8699
NPI assigned
Jun 7, 2013
Last updated
Jun 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

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

Authorized official

Name
Mrs. Teresa RuchNPI 1578809364
Title
Owner
Phone
(920) 324-8608

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3069-035 WI Primary

Addresses

Primary practice location

223 E Main St
Waupun, WI 53963-2019

Mailing address

PO Box 163
Waupun, WI 53963-0163
Phone (920) 324-8608

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1370563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370563200000",
    "number": "1053759340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 163",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539630163",
            "telephone_number": "920-324-8608",
            "fax_number": "920-324-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 E MAIN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632019",
            "telephone_number": "920-324-8608",
            "fax_number": "920-324-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAN'S OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-07",
        "last_updated": "2013-06-07",
        "status": "A",
        "authorized_official_last_name": "RUCH",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-324-8608",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3069-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupun, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.