NPIMap

Organization Active NPI

Minocqua Optical & Wellness LLC

  • Optician
  • Tomahawk, WI
National Provider Identifier
1225307242
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
Legal business name
MINOCQUA OPTICAL & WELLNESS LLC
Practice address
1334 N. 4TH Street
Suite 101
Tomahawk, WI 54487-2137
Phone
(715) 224-2200
Fax
(419) 858-9769
NPI assigned
Dec 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Authorized official

Name
Ms. Margaret Ann CoffenNPI 1083978605
Title
Owner/Optician
Phone
(715) 224-2200

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
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

1334 N. 4TH Street
Suite 101
Tomahawk, WI 54487-2137

Mailing address

1334 N 4TH St Ste 101
Tomahawk, WI 54487-2106
Phone (715) 224-2200

Other identifiers 1

IdentifierTypeStateIssuer
420969MedicaidWI

Other names 1

  • DBA Tomahawk Eyecare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240219001489 WI Part B Supplier - Clinic/Group Practice 0941644983 Receives reassigned benefits from 1 practitioner
Practice locations: Tomahawk, WI

National Provider Directory

National Provider Directory

Locations

1334 N 4th St
Tomahawk, WI 54487
Phone (715) 224-2200

Practitioners & affiliated clinicians

Practitioners 7

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": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1225307242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1334 N 4TH ST STE 101",
            "city": "TOMAHAWK",
            "state": "WI",
            "postal_code": "544872106",
            "telephone_number": "715-224-2200",
            "fax_number": "419-858-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 N. 4TH STREET",
            "address_2": "SUITE 101",
            "city": "TOMAHAWK",
            "state": "WI",
            "postal_code": "544872137",
            "telephone_number": "715-224-2200",
            "fax_number": "419-858-9769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINOCQUA OPTICAL & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-20",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "COFFEN",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/OPTICIAN",
        "authorized_official_telephone_number": "715-224-2200",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420969",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA Tomahawk Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tomahawk, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.