Annette J Wilde, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2869-035 Issued in WI

Practice address

1255 Appleton Rd
Menasha, WI 54952-1501

Phone

(920) 722-6872

Fax

(920) 722-6335

NPI assigned

Aug 29, 2005

Last updated

May 8, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Luxottica of America Inc

  dba Lenscrafters #287

  • Eyewear Supplier
  • Appleton, WI
  • NPI 1174622583
  Medicare reassignment NPD
• Luxottica of America Inc.

  dba Target Optical #C4052

  • Eyewear Supplier
  • Appleton, WI
  • NPI 1780776245
  NPD
• Luxottica of America Inc

  dba Lenscrafters #E895

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD
• Griebenow Eyecare, S.C.

  dba Griebenow Eyecare Clintonville

  • Optometrist
  • Clintonville, WI
  • NPI 1003045402
  NPD (past)
• Griebenow Eyecare, S.C.

  • Optometrist
  • New London, WI
  • NPI 1366599433
  NPD (past)
• Park Place Optical, LTD

  • Optician
  • Appleton, WI
  • NPI 1255465738
  NPD (past)

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

{
    "created_epoch": "1125273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210204800000",
    "number": "1205829942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521501",
            "telephone_number": "920-722-6872",
            "fax_number": "920-722-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 APPLETON RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521501",
            "telephone_number": "920-722-6872",
            "fax_number": "920-722-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "ANNETTE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-29",
        "last_updated": "2008-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2869-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38615000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley James Welsing
• Michelle Wenzel, OTR
• Andrew D Wheaton, PHARMD
• Kristy Lyn Wichman
• Jenny Marie Wiedmeyer, COTA
• Patrick Wiley
• Lindley Anne Wilkerson, MA, LPC
• Cathleen Starck Wille
• Davian Willems
• Brianne M Williams, PT, DPT

• Optometrist in Menasha, WI
• Providers in Menasha, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.