NPIMap

Organization Active NPI

Associated Eye Care Optical LLC

  • Eyewear Supplier
  • Hudson, WI
National Provider Identifier
1205214236
Registry record updated Oct 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
ASSOCIATED EYE CARE OPTICAL LLC
Practice address
411 Stageline Road Suite 200
Hudson, WI 54016-7848
Phone
(651) 275-3000
Fax
(651) 275-3027
NPI assigned
May 11, 2015
Last updated
Oct 24, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2017

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

Authorized official

Name
Mark S Fisher
Title
Exceutive Director
Phone
(651) 275-3002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

411 Stageline Road Suite 200
Hudson, WI 54016-7848

Mailing address

1719 Tower Dr W Suite 100
Stillwater, MN 55082-7215
Phone (651) 275-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171122000243 WI DME Supplier - Optician 9931227527 Practice locations: Hudson, WI

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Associated Eye Care Optical LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

280 Smith Ave N
Ste 840
Saint Paul, MN 55102

237 Radio Dr
Ste 100
Woodbury, MN 55125

411 Stageline Rd
#271
Hudson, WI 54016

411 Stageline Rd
Ste 271
Hudson, WI 54016

525 N Knowles Ave
#200
New Richmond, WI 54017
Phone (715) 483-1785

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508803200000",
    "number": "1205214236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 TOWER DR W SUITE 100",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827215",
            "telephone_number": "651-275-3000",
            "fax_number": "651-275-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 STAGELINE ROAD SUITE 200",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167848",
            "telephone_number": "651-275-3000",
            "fax_number": "651-275-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED EYE CARE OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2017-10-24",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EXCEUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-275-3002"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; 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.