Active NPI
Northeast Wisconsin Vision Center, LTD.
- Ophthalmology Physician
- Oshkosh, WI
National Provider Identifier
1295715415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- NORTHEAST WISCONSIN VISION CENTER, LTD.
- Practice address
- 2130 S Washburn St
Oshkosh, WI 54904-8949 - Phone
- (920) 232-6550
- Fax
- (920) 232-6552
- NPI assigned
- Jan 23, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Eric M Larson, M.D.
- Title
- President
- Phone
- (920) 232-6550
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | |||
| Ophthalmology Physician | 207W00000X | Primary |
Addresses
Primary practice location
2130 S Washburn St
Oshkosh, WI 54904-8949
Mailing address
PO Box 2723
Oshkosh, WI 54903-2723
Other practice location 1
1885 W Pointe Dr
Oshkosh, WI 54902-4174
Phone (920) 232-6550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32863800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050308000343 | WI | Part B Supplier - Clinic/Group Practice | 2961456512 |
Receives reassigned benefits from 6 practitioners Practice locations: Waupaca, WI; Ripon, WI; Oshkosh, WI; Berlin, WI; Fond Du Lac, WI; King, WI; Neenah, WI |
National Provider Directory
National Provider Directory- Tax ID family
- Northeast Wisconsin Vision Center LTD
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optician
- Ripon, WI
- NPI 1366649030
-
- Optician
- Oshkosh, WI
- NPI 1790905073
Locations
269 Memorial Dr
Ste 102
Berlin, WI 54923
Phone (800) 876-8182
1885 West Pointe Dr
Oshkosh, WI 54902
Phone (920) 232-6550
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Fond Du Lac, WI
- NPI 1295186690
-
- Optometrist
- Oshkosh, WI
- NPI 1003264318
-
- Optometrist
- Appleton, WI
- NPI 1396714812
-
- Optometrist
- Appleton, WI
- NPI 1366422735
-
- Optometrist
- Monroe, WI
- NPI 1700083169
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Northeast Wisconsin Vision Center L | Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1705363200000",
"number": "1295715415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2723",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549032723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 S WASHBURN ST",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549048949",
"telephone_number": "920-232-6550",
"fax_number": "920-232-6552"
}
],
"practiceLocations": [
{
"address_1": "1885 W Pointe Dr",
"address_purpose": "LOCATION",
"city": "Oshkosh",
"state": "WI",
"postal_code": "549024174",
"country_code": "US",
"telephone_number": "920-232-6550",
"fax_number": "920-232-6552",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "NORTHEAST WISCONSIN VISION CENTER, LTD.",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-23",
"last_updated": "2024-01-16",
"certification_date": "2024-01-16",
"status": "A",
"authorized_official_last_name": "LARSON",
"authorized_official_first_name": "ERIC",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "920-232-6550",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32863800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.