Individual provider Active NPI

Laurie Ann Robertson, O.D.

  • Optometrist
  • Kenosha, WI
National Provider Identifier
1144493792
Registry record updated Apr 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2564 - 035 Issued in WI
Practice address
6125 Green Bay Rd
Suite 800
Kenosha, WI 53142-2928
Phone
(262) 654-0726
Fax
(262) 654-4365
NPI assigned
Apr 3, 2008
Last updated
Apr 3, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2564 - 035 WI Primary

Addresses

Primary practice location

6125 Green Bay Rd
Suite 800
Kenosha, WI 53142-2928

Mailing address

7747 242ND Ave
Salem, WI 53168-9448
Phone (262) 843-2999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2564 - 035WIMDOptometrist

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18758/brand/14/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1207180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207180800000",
    "number": "1144493792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7747 242ND AVE",
            "city": "SALEM",
            "state": "WI",
            "postal_code": "531689448",
            "telephone_number": "262-843-2999",
            "fax_number": "262-843-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6125 GREEN BAY RD",
            "address_2": "SUITE 800",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422928",
            "telephone_number": "262-654-0726",
            "fax_number": "262-654-4365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "LAURIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-03",
        "last_updated": "2008-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2564 - 035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.