Organization Active NPI

Eye Care Center of New Holstein, LLC

  • Optometrist
  • New Holstein, WI
National Provider Identifier
1346385291
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYE CARE CENTER OF NEW HOLSTEIN, LLC
Practice address
1405 Milwaukee Dr
New Holstein, WI 53061-1430
Phone
(920) 898-5531
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Authorized official

Name
Dr. Cheryl M Roers, O.D.
Title
Owner
Phone
(920) 898-5531

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1405 Milwaukee Dr
New Holstein, WI 53061-1430

Mailing address

1405 Milwaukee Dr
New Holstein, WI 53061-1430
Phone (920) 898-5531

Other identifiers 1

IdentifierTypeStateIssuer
38723300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050120000017 WI Part B Supplier - Clinic/Group Practice 7517916273 Receives reassigned benefits from 7 practitioners
Practice locations: Sheboygan, WI; New Holstein, WI; Kiel, WI; Grafton, WI; Chilton, WI

National Provider Directory

National Provider Directory

Locations

17 E Main St
Chilton, WI 53014
Phone (920) 849-4642

1106 Washington St
Grafton, WI 53024
Phone (262) 375-0220

500 Fremont St
Kiel, WI 53042
Phone (920) 894-2727

1836 Wisconsin Ave
New Holstein, WI 53061
Phone (920) 898-4444

1405 Milwaukee Dr
New Holstein, WI 53061
Phone (920) 898-5531

833 Pennsylvania Ave
Ste 102
Sheboygan, WI 53081

833 Pennsylvania Ave
Sheboygan, WI 53081

2819 Superior Ave
Sheboygan, WI 53081

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1346385291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 MILWAUKEE DR",
            "city": "NEW HOLSTEIN",
            "state": "WI",
            "postal_code": "530611430",
            "telephone_number": "920-898-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 MILWAUKEE DR",
            "city": "NEW HOLSTEIN",
            "state": "WI",
            "postal_code": "530611430",
            "telephone_number": "920-898-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE CENTER OF NEW HOLSTEIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "ROERS",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-898-5531",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38723300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Holstein, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.