Winckler Vision Center, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

WINCKLER VISION CENTER, INC.

Practice address

207 E Main St Ste 1
Pine Ridge, SD 57770-3184

Phone

(605) 867-2772

Fax

(605) 867-2772

NPI assigned

Jul 26, 2006

Last updated

Jan 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark R WincklerNPI 1538268388

Title

Insurance & Credentialing

Phone

(605) 867-2772

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 1

• Pine Ridge Vision Center Other name

Medicare fee-for-service enrollment

Enrolled in SD2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

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

• Chadron Vision Center, Inc.

  • Optometrist
  • Chadron, NE
  • NPI 1245226984

  8123073574

  Same PAC ID

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark R Winckler, OD

  • Optometrist
  • Pine Ridge, SD
  • NPI 1538268388
  Medicare reassignment NPD Authorized official
• Timothy Lee Chancellor, OD

  • Optometrist
  • Chadron, NE
  • NPI 1417916321

  SD

  Medicare reassignment NPD
• Bradley C Marcy

  • Optometrist
  • Gordon, NE
  • NPI 1336581503

  SD

  Medicare reassignment NPD
• Joseph Leon Shetler, OD

  • Optometrist
  • Gordon, NE
  • NPI 1952362139
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1134142243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "address_2": "HWY 18",
            "city": "PINE RIDGE",
            "state": "SD",
            "postal_code": "577700399",
            "telephone_number": "605-867-2772",
            "fax_number": "605-867-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E MAIN ST STE 1",
            "city": "PINE RIDGE",
            "state": "SD",
            "postal_code": "577703184",
            "telephone_number": "605-867-2772",
            "fax_number": "605-867-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINCKLER VISION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "WINCKLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "INSURANCE & CREDENTIALING",
        "authorized_official_telephone_number": "605-867-2772"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "4993076",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "4993077",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "4993075",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9202143",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "4993078",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203683",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9280200",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9200333",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Ridge Vision Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Catherine Whelimina Wacondo, REGISTERED NURSE
• Susan Jean Wallace
• S Patrick Weber, M.D.
• Lea A Wells, PHARM D
• Evelyn J Weston, RN
• Mark R Winckler, OD
• Shannon Wolfinbarger, CNM
• Dawn Faye Yankton

• Optometrist in Pine Ridge, SD
• Providers in Pine Ridge, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.