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Dean Retail Services, Inc.

Organization Active NPI Optician · Waunakee, WI

NPI 1124450416 · NPPES record last updated Aug 3, 2020

Key facts

NPI
1124450416
Entity type
Organization (NPI type 2)
Primary specialty
Optician 156FX1800X
Legal business name
DEAN RETAIL SERVICES, INC.
Practice address
1300 S Century Ave
Suite 200
Waunakee, WI 53597-2386
Phone
(608) 849-4315
Fax
(608) 850-1606
NPI assigned
Aug 8, 2013
Organization subpart
No

Authorized official

Name
Amy J Grinnell
Title
Vice President Finance
Phone
(608) 260-3586

Other NPIs with the same Medicare PAC ID 20

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

Corporate family (same tax ID) 20

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20131028001762 WI DME Supplier - Optician 5395863773 Practice locations: Waunakee, WI

National Provider Directory

Tax ID family
Dean Optical (21 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optician
Group: 193200000X MULTI-SPECIALTY GROUP		 156FX1800X WI Yes
Eyewear Supplier 332H00000X WI

Addresses

Primary practice location

1300 S Century Ave
Suite 200
Waunakee, WI 53597-2386

Mailing address

1808 W Beltline Hwy
Madison, WI 53713-2334
Phone (608) 294-6218

Other identifiers

IdentifierTypeStateIssuer
100032814MedicaidWI

Other names

  • SSM Health Davis Duehr Dean Eye Care - Waunakee Doing business as

Other providers in Waunakee, WI

All providers in Waunakee, WI · Optician in Wisconsin

Sources for this page

Verify at the official NPI Registry.