Nathan Karl Eichhorst, OD

Key facts

NPI

1104894153

Entity type

Individual (NPI type 1)

Primary specialty

Optometrist 152W00000X

License

2293035 (WI)

Practice address

130 Walnut Street
Spooner, WI 54801-1319

Phone

(715) 635-2020

Fax

(715) 635-2956

NPI assigned

Mar 8, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• Northview Eye Associates LLC Optometrist · Rice Lake, WI · NPI 1215465083
  NPD (past) OPTOMETRIST

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 2, 2010.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267488000000",
    "number": "1104894153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 WALNUT STREET",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "548011319",
            "telephone_number": "715-635-2020",
            "fax_number": "715-635-2956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 WALNUT STREET",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "548011319",
            "telephone_number": "715-635-2020",
            "fax_number": "715-635-2956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EICHHORST",
        "first_name": "NATHAN",
        "middle_name": "KARL",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2010-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2293035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38584900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2200142",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "391818241013",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Spooner, WI · Optometrist in Wisconsin