Individual provider Active NPI

Bret A Ammeraal, O.D.

  • Optometrist
  • Madison, WI
National Provider Identifier
1104877398
Registry record updated Nov 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2696 Issued in WI
Practice address
2201 Zeier Rd
Madison, WI 53704-7415
Phone
(608) 246-2161
Fax
(608) 246-0136
NPI assigned
May 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2696 WI Primary

Addresses

Primary practice location

2201 Zeier Rd
Madison, WI 53704-7415

Mailing address

2201 Zeier Rd
Madison, WI 53704-7415
Phone (608) 246-2161

Other identifiers 1

IdentifierTypeStateIssuer
38450700MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060620000155 WI Practitioner - Optometry 4587676242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

3868 E Washington Ave
Suite F
Madison, WI 53704-3600
Phone (608) 246-2161

6000 Monona Dr
Suite 101
Monona, WI 53716-3329
Phone (608) 222-9420

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2696WIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Shoptikal LLC Optometrist CurrentSince May 16, 2019 Accepting new patients
Shoptikal LLC Optometrist Current Accepting new patients
Shoptikal LLC Optometrist CurrentSince May 16, 2019 Accepting new patients
Shoptikal LLC Optometrist Past Accepting new patients
Shopko Stores Operating Co LLC Past Accepting new patients

Locations

1425 Janesville Ave
Fort Atkinson, WI 53538
Phone (920) 563-2171

1640 Madison Ave
Fort Atkinson, WI 53538
Phone (920) 563-2171

3868 E Washington Ave
Ste F
Madison, WI 53704
Phone (608) 246-2161

6000 Monona Dr
Ste 101
Monona, WI 53716
Phone (608) 222-9420

2800 Sarah Ln
Ste E
Waunakee, WI 53597
Phone (608) 602-5140

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511827200000",
    "number": "1104877398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 ZEIER RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537047415",
            "telephone_number": "608-246-2161",
            "fax_number": "608-246-8573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 ZEIER RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537047415",
            "telephone_number": "608-246-2161",
            "fax_number": "608-246-0136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMMERAAL",
        "first_name": "BRET",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2017-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38450700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.