NPIMap

Organization Active NPI

Dean Retail Services, Inc.

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

  • Optician
  • Waunakee, WI
National Provider Identifier
1124450416
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
DEAN RETAIL SERVICES, INC.
Doing business as
SSM Health Davis Duehr Dean Eye Care - Waunakee
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
Last updated
Aug 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X WI Primary
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 names 1

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

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

Other NPIs with the same Medicare PAC ID 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Dean Eye Care-Lancaster21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1300 S Century Ave
Ste 200
Waunakee, WI 53597
Phone (608) 850-1650

NPI Registry JSON

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

{
    "created_epoch": "1375920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1124450416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 W BELTLINE HWY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537132334",
            "telephone_number": "608-294-6218",
            "fax_number": "608-250-1384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S CENTURY AVE",
            "address_2": "SUITE 200",
            "city": "WAUNAKEE",
            "state": "WI",
            "postal_code": "535972386",
            "telephone_number": "608-849-4315",
            "fax_number": "608-850-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN RETAIL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-08",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "GRINNELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "608-260-3586"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Davis Duehr Dean Eye Care - Waunakee",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health Davis Duehr Dean Eye Care - Waunakee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waunakee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.