NPIMap

Organization Active NPI

Optimal Vision Health, LLC

  • Optometrist
  • Hartford, WI
National Provider Identifier
1215312343
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3372-35 Issued in WI
Legal business name
OPTIMAL VISION HEALTH, LLC
Practice address
1489 E Sumner St
Hartford, WI 53027-2606
Phone
(262) 673-7737
Fax
(262) 673-7702
NPI assigned
Jul 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

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

Authorized official

Name
Michelle Kwon, O.D.NPI 1447630744
Title
Owner
Phone
(414) 345-0547

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 3372-35 WI Primary
Contact Lens FitterGroup: 193200000X MULTI-SPECIALTY GROUP 156FC0801X
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X

Addresses

Primary practice location

1489 E Sumner St
Hartford, WI 53027-2606

Mailing address

1489 E Sumner St
Hartford, WI 53027-2606
Phone (262) 673-7737

Other names 1

  • Eye Deal Optical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170726000459 WI Part B Supplier - Clinic/Group Practice 5395015275 Receives reassigned benefits from 1 practitioner
Practice locations: Hartford, WI

National Provider Directory

National Provider Directory

Locations

1489 E Sumner St
Hartford, WI 53027
Phone (262) 673-7737

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438214400000",
    "number": "1215312343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1489 E SUMNER ST",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530272606",
            "telephone_number": "262-673-7737",
            "fax_number": "262-673-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1489 E SUMNER ST",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530272606",
            "telephone_number": "262-673-7737",
            "fax_number": "262-673-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL VISION HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2015-07-30",
        "status": "A",
        "authorized_official_last_name": "KWON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-345-0547",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3372-35",
            "primary": true
        },
        {
            "code": "156FC0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Deal Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hartford, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; 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.