Vickers Eyecare, Inc
Organization Active NPI Optometrist · Minocqua, WI
NPI 1235337494 · NPPES record last updated Nov 12, 2007
Key facts
- NPI
- 1235337494
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2838-035 (WI)
- Legal business name
- VICKERS EYECARE, INC
- 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
- Organization subpart
- No
Authorized official
- Name
- Dr. C Gregory Vickers, O.D.
- Title
- President
- Phone
- (715) 358-3937
Practitioners 16
-
C. Gregory Vickers, O.D.
-
John Friedli, PA-C
-
Michele L Harma, FNP
-
Ifeoma F Nwoye, MD
-
Adam M Wennersten, PA-C
-
Eve J. Komosa, PA-C
-
Thomas F Marren, MD
-
Terry L. Steege, NP
-
Mark E Stempihar, M.D.
-
David S Wood, DPM
-
Ernie Yap, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
9815 Highway 70
Minocqua, WI 54548
Phone (715) 358-3937
9815 Highway 70
#102
Minocqua, WI 54548
Phone (715) 358-3937
9815 State Highway 70
Minocqua, WI 54548
Phone (715) 358-3937
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2838-035 | WI | Yes |
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
- Advanced Family Vision Care
Other providers in Minocqua, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.