Mark A Dagenais, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2704 Issued in WI

Practice address

3670 S 108TH St Ste 204
Milwaukee, WI 53228-1237

Phone

(414) 453-1010

Fax

(414) 425-4230

NPI assigned

Aug 10, 2005

Last updated

Aug 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peak Eye Care, SC

  • Optometrist
  • Greenfield, WI
  • NPI 1528829405
  Medicare reassignment NPD Authorized official
• The Eye Group SC

  • Optometrist
  • Waukesha, WI
  • NPI 1659332823
  Medicare reassignment NPD Authorized official
• Meadowbrook Eyecare

  • Optometrist
  • Waukesha, WI
  • NPI 1205607025
  NPD
• Stein Optical Inc.

  dba Stein Optical

  • Optometrist
  • Milwaukee, WI
  • NPI 1801829551
  NPD (past)

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1316948516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 S 108TH ST STE 204",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532281237",
            "telephone_number": "414-453-1010",
            "fax_number": "262-542-9439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 S 108TH ST STE 204",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532281237",
            "telephone_number": "414-453-1010",
            "fax_number": "414-425-4230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGENAIS",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38603400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Dabrowski, MD
• Russell C. Dabrowski, M.D.
• Michelle Natalie Dacosta, DDS
• Sofia Grace Dacquisto, DDS
• Shekhar A Dagam, M.D.
• Yimenu W. Dagnew, M.D.
• Heather Lynn Dague, M.D.
• Nora Dahbur, MD
• Manal A Dahcha, PHARMD
• Aziza Daher, LPC

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

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

Verify at the official NPI Registry.