NPIMap

Organization Active NPI

Milton & Edgerton Vision Centers, LLC

Doing business as Edgerton Vision Center

  • Optometrist
  • Edgerton, WI
National Provider Identifier
1194932111
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1749 Issued in WI
Legal business name
MILTON & EDGERTON VISION CENTERS, LLC
Doing business as
Edgerton Vision Center
Practice address
1110 N Main St
Edgerton, WI 53534-1328
Phone
(608) 884-3314
Fax
(608) 884-4923
NPI assigned
May 17, 2007
Last updated
Feb 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Authorized official

Name
Dr. Jayme Nicole Long, ODNPI 1497169403
Title
Doctor/Co-Owner
Phone
(608) 884-3314

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1749 WI Primary

Addresses

Primary practice location

1110 N Main St
Edgerton, WI 53534-1328

Mailing address

1110 N Main St
Edgerton, WI 53534-1328
Phone (608) 884-3314

Other identifiers 1

IdentifierTypeStateIssuer
38514300MedicaidWI

Other names 1

  • Edgerton Vision Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211213000864 WI Part B Supplier - Clinic/Group Practice 3072903749 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Edgerton, WI; Milton, WI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Edgerton Vision Center2 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.

Locations

641 E Saint Mary St
Milton, WI 53563
Phone (608) 868-4651

Practitioners & affiliated clinicians

Practitioners 2

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": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1194932111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 N MAIN ST",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535341328",
            "telephone_number": "608-884-3314",
            "fax_number": "608-884-4923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 N MAIN ST",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535341328",
            "telephone_number": "608-884-3314",
            "fax_number": "608-884-4923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILTON & EDGERTON VISION CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "JAYME",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "DOCTOR/CO-OWNER",
        "authorized_official_telephone_number": "608-884-3314",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38514300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgerton Vision Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Edgerton Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgerton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; 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.