NPIMap

Organization Active NPI

Delafield Vision Center LTD

  • Optometrist
  • Delafield, WI
National Provider Identifier
1356487995
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2609035 Issued in WI
Legal business name
DELAFIELD VISION CENTER LTD
Practice address
3175 Gold Rd
Delafield, WI 53018-2156
Phone
(262) 646-7400
Fax
(262) 646-7413
NPI assigned
Jan 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

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

Authorized official

Name
Dr. Julia P Johnson, ODNPI 1770765638
Title
Owner
Phone
(262) 646-7400

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 2609035 WI Primary

Addresses

Primary practice location

3175 Gold Rd
Delafield, WI 53018-2156

Mailing address

3175 Gold Rd
Delafield, WI 53018-2156
Phone (262) 646-7400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071221000318 WI Part B Supplier - Clinic/Group Practice 8921198383 Receives reassigned benefits from 1 practitioner
Practice locations: Delafield, WI
O20100930016108 WI DME Supplier - Physician - OptometristDME Supplier - Optician 8921198383 Practice locations: Delafield, WI

National Provider Directory

National Provider Directory

Locations

3175 Golf Rd
Delafield, WI 53018
Phone (262) 646-7400

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219881600000",
    "number": "1356487995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 GOLD RD",
            "city": "DELAFIELD",
            "state": "WI",
            "postal_code": "530182156",
            "telephone_number": "262-646-7400",
            "fax_number": "262-646-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 GOLD RD",
            "city": "DELAFIELD",
            "state": "WI",
            "postal_code": "530182156",
            "telephone_number": "262-646-7400",
            "fax_number": "262-646-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAFIELD VISION CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2008-08-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-646-7400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2609035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delafield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; 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.