Active NPI
Jill A Anderson, O.D.
- Optometrist
- Appleton, WI
National Provider Identifier
1366422735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2651-035
- Practice address
- 1000 N Westhill Blvd
Optical
Appleton, WI 54914-5792 - Phone
- (920) 733-7804
- Fax
- (920) 733-7940
- NPI assigned
- Jan 20, 2006
- Last updated
- Jun 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2651-035 | WI | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI, NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2651-035 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Wisconsin Vision Center, LTD. | Optometrist | Past | Accepting new patients |
| Dr. Jill Anderson & Associates, LLC | Optometrist | Past | Accepting new patients |
| Northeast Wisconsin Vision Center, LTD | Past | Accepting new patients |
Organizations & group practices 5
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.
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Optometrist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275955200000",
"number": "1366422735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1123 BERLIN ST",
"city": "WAUPACA",
"state": "WI",
"postal_code": "549811920",
"telephone_number": "715-340-0496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 N WESTHILL BLVD",
"address_2": "OPTICAL",
"city": "APPLETON",
"state": "WI",
"postal_code": "549145792",
"telephone_number": "920-733-7804",
"fax_number": "920-733-7940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JILL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-20",
"last_updated": "2010-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "2651-035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.