NPIMap

Organization Active NPI

Ophthalmic Surgery of Wi LTD

  • Ophthalmology Physician
  • Oshkosh, WI
National Provider Identifier
1093881609
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
OPHTHALMIC SURGERY OF WI LTD
Practice address
509 S Washburn St
Oshkosh, WI 54904-7949
Phone
(920) 236-4160
Fax
(920) 236-4166
NPI assigned
Nov 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Authorized official

Name
Gerald P Clarke, M.D.
Title
President
Phone
(920) 236-4160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X WI Primary

Addresses

Primary practice location

509 S Washburn St
Oshkosh, WI 54904-7949

Mailing address

PO Box 308
Neenah, WI 54957-0308
Phone (920) 236-4162

Other identifiers 2

IdentifierTypeStateIssuer
CS8378OtherWIRETIRED RAILROAD MEDICARE
32704500MedicaidWI

Other names 1

  • Ophthalmic Surgery of Wisconsin Ltd Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1093881609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549570308",
            "telephone_number": "920-236-4162",
            "fax_number": "920-236-4166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 S WASHBURN ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549047949",
            "telephone_number": "920-236-4160",
            "fax_number": "920-236-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMIC SURGERY OF WI LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-236-4160",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RETIRED RAILROAD MEDICARE",
            "identifier": "CS8378",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32704500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ophthalmic Surgery of Wisconsin Ltd",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; 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.