Jill A Anderson, O.D.
Individual provider Active NPI Optometrist · Appleton, WI
NPI 1366422735 · NPPES record last updated Jun 8, 2010
Key facts
- NPI
- 1366422735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2651-035 (WI)
- Practice address
- 1000 N Westhill Blvd
Optical
Appleton, WI 54914-5792 - Phone
- (920) 733-7804
- Fax
- (920) 733-7940
- NPI assigned
- Jan 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050523001125 | WI | Practitioner - Optometry | 2466494232 | |
| I20221028000281 | NC | Practitioner - Optometry | 2466494232 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2651-035 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Jill Anderson & Associates, LLC | Optometrist | Past | Accepting new patients |
| Northeast Wisconsin Vision Center, LTD | Past | Accepting new patients | |
| Northeast Wisconsin Vision Center, LTD. | Optometrist | Past |
Accepting new patients |
| Shopko Stores Operating Co LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2651-035 | WI | Yes |
Addresses
Primary practice location
1000 N Westhill Blvd
Optical
Appleton, WI 54914-5792
Mailing address
1123 Berlin St
Waupaca, WI 54981-1920
Phone (715) 340-0496
Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.