Mayville Vision Center, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

WI 2915-035 Issued in WI

Legal business name

MAYVILLE VISION CENTER, INC.

Practice address

935 Horicon St
Mayville, WI 53050-1428

Phone

(920) 387-3180

Fax

(920) 387-9636

NPI assigned

Aug 5, 2008

Last updated

Jun 17, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Cassandre Bezold Hetzer, O.D.NPI 1184626228

Title

Optometrist/President

Phone

(920) 387-3180

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Cassandre Bezold Hetzer, O.D.

  • Optometrist
  • Mayville, WI
  • NPI 1184626228
  Authorized official Same address or phone

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1275799629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 HORICON ST",
            "city": "MAYVILLE",
            "state": "WI",
            "postal_code": "530501428",
            "telephone_number": "920-387-3180",
            "fax_number": "920-387-9636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 HORICON ST",
            "city": "MAYVILLE",
            "state": "WI",
            "postal_code": "530501428",
            "telephone_number": "920-387-3180",
            "fax_number": "920-387-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYVILLE VISION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-05",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "HETZER",
        "authorized_official_first_name": "CASSANDRE",
        "authorized_official_middle_name": "BEZOLD",
        "authorized_official_title_or_position": "OPTOMETRIST/PRESIDENT",
        "authorized_official_telephone_number": "920-387-3180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "WI 2915-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38617900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marshland Drugs Inc (Marshland Compounding Center)
• Mayville Chiropractic Center LLC
• Mayville Hometown Pharmacy LLC (Mayville Hometown Pharmacy)
• Mayville Nursing and Rehab
• Mayville Nursing and Rehabilitation Center
• Mayville Vision LLC
• Sarah Jo Mireski, PHARMD. RPH
• Kayla Jo Nonhof, APSW, SAC-IT
• Nicholas Anthony Novotny, DDS
• Kaelan C Pieper, COTA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.