Nathan Michael Larson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3916-35 Issued in WI

Practice address

1255 Appleton Rd
Menasha, WI 54952-1501

Phone

(920) 722-6872

NPI assigned

Jun 7, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Eyecare IncGroup PAC ID 5092770743, 4 clinicians

Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Eyecare Inc

  • Optometrist
  • Brillion, WI
  • NPI 1548457757
  Medicare reassignment Care Compare group NPD
• Shoptikal LLC

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159

  Optometrist

  Medicare reassignment Care Compare group NPD
• Community Eyecare Inc

  • Optometrist
  • Black Creek, WI
  • NPI 1528333788
  NPD
• Community Eyecare Inc

  • Optometrist
  • Menasha, WI
  • NPI 1861463234
  NPD
• Shoptikal LLC

  • Eyewear Supplier
  • Pewaukee, WI
  • NPI 1932767316

  Optometrist

  NPD
• Shoptikal LLC

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1073207445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521501",
            "telephone_number": "920-722-6872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521501",
            "telephone_number": "920-722-6872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "NATHAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3916-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Lynn Lancaste-Gassen, LPN
• Lisa Lynn Lang Riegel, DDS
• Robert Charles Lang, DDS
• Amy Elizabeth Langeberg, OTD, OTR/L
• Alissa Ruth Lapp, LPC-IT
• Lesley R Lathrop, R N
• Melissa L Laughlin Holtz, LCSW
• Darlene Leary
• Avery Ann Lebowitz, APNP
• Kelly Marie Lehman, MSCCCSLP

• Optometrist in Menasha, WI
• Providers in Menasha, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.