Vita Park Eye Associates, SC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

VITA PARK EYE ASSOCIATES, SC

Practice address

240 Corporate Drive
Beaver Dam, WI 53916

Phone

(920) 887-1151

Fax

(920) 887-3353

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Thomas A Castillo, DO

Title

Corporate Officer

Phone

(920) 887-1151

Specialties & licenses 2

Addresses

Other identifiers 2

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Vita Park Eye Associates, SC

  • Ophthalmology Physician
  • Beaver Dam, WI
  • NPI 1447276894
  NPPES parent name
• Vita Park Eye Associates, SC

  • Optometrist
  • Waupun, WI
  • NPI 1548286909
  NPPES parent name

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1154418051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 CORPORATE DRIVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "53916",
            "telephone_number": "920-887-1151",
            "fax_number": "920-887-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 CORPORATE DRIVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "53916",
            "telephone_number": "920-887-1151",
            "fax_number": "920-887-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITA PARK EYE ASSOCIATES, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CORPORATE OFFICER",
        "authorized_official_telephone_number": "920-887-1151",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CP765",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21310700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Vansusteren, MS, LPC-IT
• Vein Care Associates S.C.
• Prabhu Venkataraman, LPC-IT
• Victor W. Caceres, M.D.,S.C.
• Lynda K Vielbig, CRNA
• Vita Park Eye Associates, SC
• Katherine M Volz, PT, DPT
• Vop Beaver Dam, LLC
• Lindsey Joann Wagner-Hron, LCSW, CSAC
• Kellie Marie Wagner, PT, DPT, CSCS

• Ophthalmology Physician in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Ophthalmology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.