Stateline Vision Center LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3082 Issued in WI

Legal business name

STATELINE VISION CENTER LLC

Practice address

250 N 18TH Ave Ste 105
Monroe, WI 53566-1482

Phone

(920) 216-3133

NPI assigned

Mar 17, 2015

Organization subpart

No

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

Authorized official

Name

Andrew M Josephs, O.D.NPI 1700083169

Title

Sole Proprietor

Phone

(608) 325-7200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew M Josephs, OD

  • Optometrist
  • Monroe, WI
  • NPI 1700083169
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1104219039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N 18TH AVE STE 105",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535661482",
            "telephone_number": "608-325-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N 18TH AVE STE 105",
            "city": "MONROE",
            "state": "WI",
            "postal_code": "535661482",
            "telephone_number": "920-216-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATELINE VISION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "JOSEPHS",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "608-325-7200",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Soja, ATC
• Dustin Mark Sonday, D.C.
• Danyel Speich
• Emily Sprague
• Tara Jean Stateler, D.C.
• Olivia A Stauffacher, PA
• Erin Elizabeth Stauffer, MA, CCC-SLP
• Anita Maria Stein
• Steven Franson
• Ida Lyn Stevenson, COTA/L

• Optometrist in Monroe, WI
• Providers in Monroe, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.