Individual provider Active NPI

John F. Weaver, OD

  • Optometrist
  • West Bend, WI
National Provider Identifier
1134208010
Registry record updated Jan 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2573 Issued in WI
Practice address
205 Valley Ave
West Bend, WI 53095-5312
Phone
(262) 338-1123
NPI assigned
Nov 3, 2006
Last updated
Jan 26, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2573 WI Primary

Addresses

Primary practice location

205 Valley Ave
West Bend, WI 53095-5312

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other identifiers 1

IdentifierTypeStateIssuer
38631100MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jweaver13353@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070131000685 WI Practitioner - Optometry 0749282952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

205 Valley Ave
West Bend, WI 53095-5312
Phone (262) 338-1123

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2573WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare, Inc. CurrentSince Mar 14, 2011 Accepting new patients
Aurora Advanced Healthcare Inc CurrentSince Mar 14, 2011 Accepting new patients
Lenscrafters Optometrist Past Accepting new patients
Luxottica of America Inc Past Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

1640 E Sumner St
Hartford, WI 53027
Phone (262) 670-4000

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

4850 S 74th St
Milwaukee, WI 53220
Phone (414) 282-3200

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

205 Valley Ave
West Bend, WI 53095
Phone (262) 338-1123

Interoperability endpoints

  • Direct secure messaging: jweaver13353@direct.myadvocateaurora.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737849600000",
    "number": "1134208010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 VALLEY AVE",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530955312",
            "telephone_number": "262-338-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "JOHN",
        "middle_name": "F.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2025-01-26",
        "certification_date": "2025-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38631100",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jweaver13353@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "205 Valley Ave",
            "city": "West Bend",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530955312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "205 Valley Ave",
            "city": "West Bend",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530955312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.