Organization Active NPI

Medical Eye Clinic of Eau Claire

  • Eyewear Supplier
  • Eau Claire, WI
National Provider Identifier
1073710968
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
17337 Issued in WI
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

Updated by the provider on Apr 21, 2015

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
38444400MedicaidWI

Other names 1

  • Eau Claire Optical Doing business as

National Provider Directory

National Provider Directory

Locations

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.

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.

Verify at the official NPI Registry.