Mark Arthur Ebben, OD OPTOMETRIST

Primary specialty

OptometristTaxonomy code 152W00000X

License

1618035 Issued in WI

Practice address

1 Bank Ave
Kaukauna, WI 54130-2581

Phone

(920) 766-2481

Fax

(920) 766-3769

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Mark Arthur Ebben Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Magiera Eyecare LLC

  • Optometrist
  • Kaukauna, WI
  • NPI 1154456093
  NPD

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1255389201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BANK AVE",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "54130",
            "telephone_number": "920-766-2481",
            "fax_number": "920-766-3769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BANK AVE",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541302581",
            "telephone_number": "920-766-2481",
            "fax_number": "920-766-3769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBBEN",
        "first_name": "MARK",
        "middle_name": "ARTHUR",
        "name_prefix": "Dr.",
        "credential": "OD OPTOMETRIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1618035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38700400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "EBBEN",
            "middle_name": "ARTHUR",
            "prefix": "DR.",
            "credential": "LLC OPTOMETRIST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Samantha Joan Diver, RN
• Holly L Doughty, LPC
• Anthony James Dragosh, D.C.
• Marilyn Rae Dragosh, D.C.
• Trish L Dragosh, M.T.
• William J. Farrow, D.D.S.
• Amy Fehlauer, PTA
• Staci Ferg, BCBA
• Robin M Fischer, LPC
• Beth M Fluette, RN

• Optometrist in Kaukauna, WI
• Providers in Kaukauna, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.