Michael Joseph Bannon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3625-35 Issued in WI

Practice address

1500 S Church St
Watertown, WI 53094-6404

Phone

(920) 261-9225

NPI assigned

Jul 1, 2020

Last updated

Jul 1, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Shoptikal LLC

  dba Shopko Optical 4002

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159

  Optometrist

  Medicare reassignment Care Compare group NPD
• Shoptikal LLC

  dba Fielmann Vision Care 4313

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4244

  • Eyewear Supplier
  • Hales Corners, WI
  • NPI 1023691797

  Optometrist

  NPD (past)
• Shoptikal LLC

  dba Shopko Optical 4217

  • Eyewear Supplier
  • Waukesha, WI
  • NPI 1548826951

  Optometrist

  NPD (past)
• Shoptikal LLC

  dba Shopko Optical 4238

  • Eyewear Supplier
  • Hartford, WI
  • NPI 1912598830

  Optometrist

  NPD (past)
• Shoptikal LLC

  dba Shopko Optical 4219

  • Eyewear Supplier
  • Pewaukee, WI
  • NPI 1932767316

  Optometrist

  NPD (past)
• Shoptikal LLC

  dba Shopko Optical 4066

  • Eyewear Supplier
  • Spokane, WA
  • NPI 1154987535

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1124645585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 POPLAR PATH",
            "city": "DELAFIELD",
            "state": "WI",
            "postal_code": "530181828",
            "telephone_number": "262-490-7697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S CHURCH ST",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530946404",
            "telephone_number": "920-261-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNON",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-01",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3625-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffery Allen Aussprung, ATC
• Kaci Lee Axelson, MD
• Kalie Bach, MS, LPC-IT, NCC
• Hannah Baker, DPT
• Karla Bakke, PA-C
• Maryanne Barber
• Timothy M Barnes, PT
• Samantha Barnett
• Sarah J Barnett, PA C
• John R Basarich, MD

• Optometrist in Watertown, WI
• Providers in Watertown, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.