Active NPI
Medical Eye Clinic of Eau Claire
- Eyewear Supplier
- Eau Claire, WI
National Provider Identifier
1073710968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- License
- 17337
- Legal business name
- MEDICAL EYE CLINIC OF EAU CLAIRE
- Doing business as
- Eau Claire Optical
- Practice address
- 2715 Damon St
Suite 200
Eau Claire, WI 54701-2634 - Phone
- (715) 834-5644
- Fax
- (715) 834-5674
- NPI assigned
- Jul 2, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Roy A Olson, M.D.
- Title
- Owner
- Phone
- (715) 834-5644
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | 17337 | WI | Primary |
Addresses
Primary practice location
2715 Damon St
Suite 200
Eau Claire, WI 54701-2634
Mailing address
2715 Damon St
Suite 200
Eau Claire, WI 54701-2634
Phone (715) 834-5644
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38444400 | Medicaid | WI |
Other names 1
- Eau Claire Optical
National Provider Directory
National Provider DirectoryLocations
2715 Damon St
Ste 200
Eau Claire, WI 54701
Phone (715) 834-5644
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Ophthalmology Physician
- Eau Claire, WI
- NPI 1639171614
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183334400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1429574400000",
"number": "1073710968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2715 DAMON ST",
"address_2": "SUITE 200",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547012634",
"telephone_number": "715-834-5644",
"fax_number": "715-834-5674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2715 DAMON ST",
"address_2": "SUITE 200",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547012634",
"telephone_number": "715-834-5644",
"fax_number": "715-834-5674"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDICAL EYE CLINIC OF EAU CLAIRE",
"organizational_subpart": "NO",
"enumeration_date": "2007-07-02",
"last_updated": "2015-04-21",
"status": "A",
"authorized_official_last_name": "OLSON",
"authorized_official_first_name": "ROY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "715-834-5644",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": "WI",
"license": "17337",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38444400",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Eau Claire Optical",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Eau Claire, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.