NPIMap

Organization Active NPI

Hayward Family Eye Care, Inc

  • Optometrist
  • Hayward, WI
National Provider Identifier
1053769547
Registry record updated Jan 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2235-35 Issued in WI
Legal business name
HAYWARD FAMILY EYE CARE, INC
Practice address
15569 Railroad St
Suite 301
Hayward, WI 54843-5706
Phone
(715) 634-8616
NPI assigned
May 25, 2016
Last updated
Jan 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2017

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

Authorized official

Name
Timothy Frederiksen, O.D.NPI 1649262478
Title
Owner/Optometrist
Phone
(715) 271-9899

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 2235-35 WI Primary

Addresses

Primary practice location

15569 Railroad St
Suite 301
Hayward, WI 54843-5706

Mailing address

1200 Park Creek CT
Fall Creek, WI 54742-5316
Phone (715) 271-9899

Other identifiers 1

IdentifierTypeStateIssuer
38577900MedicaidWI

National Provider Directory

National Provider Directory

Locations

15569 Railroad St
Ste 301
Hayward, WI 54843
Phone (715) 236-7906

Practitioners & affiliated clinicians

Practitioners 4

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": "1464134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484179200000",
    "number": "1053769547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 PARK CREEK CT",
            "city": "FALL CREEK",
            "state": "WI",
            "postal_code": "547425316",
            "telephone_number": "715-271-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15569 RAILROAD ST",
            "address_2": "SUITE 301",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548435706",
            "telephone_number": "715-634-8616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYWARD FAMILY EYE CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-25",
        "last_updated": "2017-01-12",
        "status": "A",
        "authorized_official_last_name": "FREDERIKSEN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "715-271-9899",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2235-35",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38577900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2017; 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.