Active NPI
William Hershey Evans, O.D.
- Optometrist
- Richland Center, WI
National Provider Identifier
1225034200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1664
- Practice address
- 165 W Haseltine St
Richland Center, WI 53581-2552 - Phone
- (608) 647-8995
- Fax
- (608) 647-2569
- NPI assigned
- Jun 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT 6649 TPA | CA | |
| Optometrist | 152W00000X | 1664 | WI | Primary |
Addresses
Primary practice location
165 W Haseltine St
Richland Center, WI 53581-2552
Mailing address
165 W Haseltine St
Richland Center, WI 53581-2552
Phone (608) 647-8995
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38630900 | Medicaid | WI | |
| 60700 | Other | WI | DEAN HEALTH INSURANCE |
| 2029369 | Other | WI | PHYSICIANS PLUS |
| SD0066490 | Medicaid | CA | |
| SD0066490 | Other | CA | BLUE SHIELD PROVIDER ID# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT 6649 TPA | CA | MD | Optometrist |
| 1664 | WI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1225034200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 W HASELTINE ST",
"city": "RICHLAND CENTER",
"state": "WI",
"postal_code": "535812552",
"telephone_number": "608-647-8995",
"fax_number": "608-647-2569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 W HASELTINE ST",
"city": "RICHLAND CENTER",
"state": "WI",
"postal_code": "535812552",
"telephone_number": "608-647-8995",
"fax_number": "608-647-2569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "WILLIAM",
"middle_name": "HERSHEY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-23",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT 6649 TPA",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1664",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38630900",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH INSURANCE",
"identifier": "60700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS PLUS",
"identifier": "2029369",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0066490",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER ID#",
"identifier": "SD0066490",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richland Center, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.