Jacob Andrew Woldt, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

692 Issued in SD

Practice address

1087 W Mason St
Green Bay, WI 54303-1859

Phone

(920) 499-3102

Fax

(920) 499-9636

NPI assigned

Aug 9, 2012

Last updated

Dec 22, 2021By 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 3

Addresses

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

Indiana University - School of Optometry, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tower Clock Eye Center SCGroup PAC ID 6305890781, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.woldt@towerclockeyecenter.direct.eyemdemr.com

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.

• Tower Clock Eye Center SC

  • Ophthalmology Physician
  • Green Bay, WI
  • NPI 1801998729
  Medicare reassignment Care Compare group NPD
• Tower Clock Eye Center SC

  • Eyewear Supplier
  • Appleton, WI
  • NPI 1376272047

  Optometrist

  NPD

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1336496355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1087 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543031859",
            "telephone_number": "920-499-3102",
            "fax_number": "920-499-9636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1087 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543031859",
            "telephone_number": "920-499-3102",
            "fax_number": "920-499-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLDT",
        "first_name": "JACOB",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-09",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3615",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "002598",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Wittmer
• Lisa Ann Witzke-Frost, D.C.
• Vickie J Woelfel, NP
• John J Woest, LPC
• Nina Wokhlu, M.D.
• Joseph M Woldt, DPT
• Beckysue Wolf, APNP
• Judith K Wolf, M.D.
• Taylor L Wolf
• John Joseph Wolff

• Optometrist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.