Cardinal Family Eye Care LLC
Organization Active NPI Optometrist · Thorp, WI
NPI 1083808802 · NPPES record last updated Feb 21, 2008
Key facts
- NPI
- 1083808802
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 3083-035 (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
- Organization subpart
- No
Authorized official
- Name
- Jacob B Vergin, OD
- Title
- Managing Partner
- Phone
- (715) 861-5253
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 1
Practitioners 4
-
Ryan Edward Beloungy, O.D.
-
Tori J. Flood, O.D.
-
Jacob B Vergin, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 3083-035 | WI | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38726700 | Medicaid | WI |
Other providers in Thorp, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.