NPIMap

Organization Active NPI

Cardinal Family Eye Care LLC

  • Optometrist
  • Thorp, WI
National Provider Identifier
1083808802
Registry record updated Feb 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3083-035 Issued in WI
Legal business name
CARDINAL FAMILY EYE CARE LLC
Practice address
102 E Stanley St
Thorp, WI 54771-9649
Phone
(715) 669-5631
Fax
(715) 669-5353
NPI assigned
Sep 5, 2007
Last updated
Feb 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2008

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

Authorized official

Name
Jacob B Vergin, ODNPI 1710185442
Title
Managing Partner
Phone
(715) 861-5253

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 3083-035 WI Primary

Addresses

Primary practice location

102 E Stanley St
Thorp, WI 54771-9649

Mailing address

102 E Stanley St
PO Box 468
Thorp, WI 54771-9649
Phone (715) 669-5631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071203000384 WI Part B Supplier - Clinic/Group Practice 7012006760 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Chippewa Falls, WI; Thorp, WI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

201 E Hill St
Thorp, WI 54771
Phone (715) 669-5631

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203552000000",
    "number": "1083808802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E STANLEY ST",
            "address_2": "PO BOX 468",
            "city": "THORP",
            "state": "WI",
            "postal_code": "547719649",
            "telephone_number": "715-669-5631",
            "fax_number": "715-669-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E STANLEY ST",
            "city": "THORP",
            "state": "WI",
            "postal_code": "547719649",
            "telephone_number": "715-669-5631",
            "fax_number": "715-669-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDINAL FAMILY EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2008-02-21",
        "status": "A",
        "authorized_official_last_name": "VERGIN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "715-861-5253",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3083-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thorp, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.