Antigo Vision Clinic SC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1477-35 Issued in WI

Legal business name

ANTIGO VISION CLINIC SC

Practice address

714 3Rd Ave
Antigo, WI 54409-2044

Phone

(715) 623-2180

Fax

(715) 623-7244

NPI assigned

Nov 5, 2007

Last updated

Aug 26, 2008By 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. Richard Arthur Kjome, ODNPI 1205992088

Title

President

Phone

(715) 623-2180

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.

• Richard A Kjome, O.D.

  • Optometrist
  • Antigo, WI
  • NPI 1205992088
  Authorized official Same address or phone

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1295915460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 3RD AVE",
            "address_2": "PO BOX 238",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544092044",
            "telephone_number": "715-623-2180",
            "fax_number": "715-623-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 3RD AVE",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544092044",
            "telephone_number": "715-623-2180",
            "fax_number": "715-623-7244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIGO VISION CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-05",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "KJOME",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-623-2180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1477-35",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38563700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antigo Eye Care Center
• Antigo Family Chiropractic Center LLC
• Antigo Medical Building, LLC
• Antigo Total Therapy & Sports Rehab Center Inc
• Antigo Vans LLC
• Douglas Paul Armato, MD
• Wendee M. Arrowood, RDHP
• Aspirus Doctors Clinic (Aspirus Doctors Clinic Cardiology Clinic Antigo)
• Aspirus Medical Group, Inc. (Aspirus General Clinic)
• Justin Bal, DPT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; 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.