NPIMap

Organization Active NPI

Family Vision & Contact Lens Centers, S.C.

  • Optometrist
  • Burlington, WI
National Provider Identifier
1093935504
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FAMILY VISION & CONTACT LENS CENTERS, S.C.
Practice address
309 McHenry St
Burlington, WI 53105
Phone
(262) 763-0117
Fax
(262) 763-0119
NPI assigned
Apr 26, 2007
Last updated
Mar 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

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

Authorized official

Name
Dr. Robert Lawrence Fait, ODNPI 1972548386
Title
Owner
Phone
(262) 763-0117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

309 McHenry St
Burlington, WI 53105

Mailing address

PO Box 630
309 McHenry St
Burlington, WI 53105
Phone (262) 763-0117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060306000287 WI Part B Supplier - Clinic/Group Practice 9133135734 Receives reassigned benefits from 7 practitioners
Practice locations: Burlington, WI; Mukwonago, WI; Oak Creek, WI; Twin Lakes, WI
O20100930076298 WI DME Supplier - Physician - Optometrist 9133135734 Practice locations: Burlington, WI

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Family Vision Contact5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

309 McHenry St
Burlington, WI 53105
Phone (262) 763-0117

920 Greenwald Ct
Mukwonago, WI 53149

8469 S Howell Ave
Oak Creek, WI 53154

8469 S Howell Ave
#2
Oak Creek, WI 53154
Phone (414) 768-0110

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 9

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": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1093935504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 630",
            "address_2": "309 MCHENRY ST",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "53105",
            "telephone_number": "262-763-0117",
            "fax_number": "262-763-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 MCHENRY ST",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "53105",
            "telephone_number": "262-763-0117",
            "fax_number": "262-763-0119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY VISION & CONTACT LENS CENTERS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "FAIT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-763-0117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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.