NPIMap

Individual provider Active NPI

Edward Karl Melberg, O.D.

  • Optometrist
  • Chippewa Falls, WI
National Provider Identifier
1124078829
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1822 Issued in WI
Practice address
2677 S Prairie View Rd
Chippewa Falls, WI 54729-7506
Phone
(715) 726-1671
Fax
(715) 726-1587
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1822 WI Primary

Addresses

Primary practice location

2677 S Prairie View Rd
Chippewa Falls, WI 54729-7506

Mailing address

16757 121St Ave
Chippewa Falls, WI 54729-6173
Phone (715) 288-6115

Other identifiers 1

IdentifierTypeStateIssuer
38521300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shopko Stores Operating Co LLC Past Accepting new patients
Shopko Stores, Inc. Past Accepting new patients

Organizations & group practices 2

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1124078829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16757 121ST AVE",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547296173",
            "telephone_number": "715-288-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2677 S PRAIRIE VIEW RD",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547297506",
            "telephone_number": "715-726-1671",
            "fax_number": "715-726-1587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELBERG",
        "first_name": "EDWARD",
        "middle_name": "KARL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38521300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chippewa Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.