NPIMap

Organization Active NPI

Vickers Eyecare, Inc

Doing business as Advanced Family Vision Care

  • Optometrist
  • Minocqua, WI
National Provider Identifier
1235337494
Registry record updated Nov 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2838-035 Issued in WI
Legal business name
VICKERS EYECARE, INC
Doing business as
Advanced Family Vision Care
Practice address
9815 Hwy 70 West
Suite 102
Minocqua, WI 54548-0971
Phone
(715) 358-3937
Fax
(715) 358-7677
NPI assigned
Jul 10, 2007
Last updated
Nov 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2007

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

Authorized official

Name
Dr. C Gregory Vickers, O.D.NPI 1801827456
Title
President
Phone
(715) 358-3937

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2838-035 WI Primary

Addresses

Primary practice location

9815 Hwy 70 West
Suite 102
Minocqua, WI 54548-0971

Mailing address

9815 Hwy 70 West, Suite 102
PO Box 971
Minocqua, WI 54548-0971
Phone (715) 358-3937

Other names 1

  • Advanced Family Vision Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071127000617 WI Part B Supplier - Clinic/Group Practice 4688763790 Receives reassigned benefits from 3 practitioners
Practice locations: Eagle River, WI; Minocqua, WI

National Provider Directory

National Provider Directory

Locations

9815 Highway 70
Minocqua, WI 54548
Phone (715) 358-3937

9815 State Highway 70
Minocqua, WI 54548
Phone (715) 358-3937

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194825600000",
    "number": "1235337494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9815 HWY 70 WEST, SUITE 102",
            "address_2": "PO BOX 971",
            "city": "MINOCQUA",
            "state": "WI",
            "postal_code": "545480971",
            "telephone_number": "715-358-3937",
            "fax_number": "715-358-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9815 HWY 70 WEST",
            "address_2": "SUITE 102",
            "city": "MINOCQUA",
            "state": "WI",
            "postal_code": "545480971",
            "telephone_number": "715-358-3937",
            "fax_number": "715-358-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKERS EYECARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-11-12",
        "status": "A",
        "authorized_official_last_name": "VICKERS",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-358-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2838-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Family Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minocqua, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; 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.