NPIMap

Organization Active NPI

St Croix Falls Eye Associates

Doing business as Grantsburg Eye Associates

  • Optometrist
  • Grantsburg, WI
National Provider Identifier
1174653133
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2608-035 Issued in WI
Legal business name
ST CROIX FALLS EYE ASSOCIATES
Doing business as
Grantsburg Eye Associates
Practice address
617 S Pine St
Grantsburg, WI 54840-7935
Phone
(715) 463-2370
Fax
(608) 571-0088
NPI assigned
Mar 7, 2007
Last updated
Jun 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Authorized official

Name
Michelle Hall
Title
Credentialing
Phone
(715) 483-3259

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2608-035 WI Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2589-035 WI

Addresses

Primary practice location

617 S Pine St
Grantsburg, WI 54840-7935

Mailing address

PO Box 767
Saint Croix Falls, WI 54024-0767
Phone (715) 483-3259

Other names 1

  • Grantsburg Eye Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816001181 WI Part B Supplier - Clinic/Group Practice 0244203412 Receives reassigned benefits from 3 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Croix Falls, WI; Webster, WI; Grantsburg, WI; Frederic, WI

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Grantsburg Eye Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1174653133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540240767",
            "telephone_number": "715-483-3259",
            "fax_number": "608-571-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 S PINE ST",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407935",
            "telephone_number": "715-463-2370",
            "fax_number": "608-571-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX FALLS EYE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "715-483-3259"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2608-035",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2589-035",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grantsburg Eye Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grantsburg Eye Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grantsburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.