Andrey Ianovski, OD
Individual provider Active NPI Optometrist · Oak Creek, WI
NPI 1376007229 · NPPES record last updated Jan 24, 2019
Key facts
- NPI
- 1376007229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 353735 (WI)
- Practice address
- 8661 S Howell Ave Ste 200
Oak Creek, WI 53154-2919 - Phone
- (414) 847-0164
- NPI assigned
- Jan 24, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- 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 |
|---|---|---|---|---|
| I20240607002663 | WI | Practitioner - Optometry | 5496297293 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 353735 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Visionworks, Inc. | Optometrist | Current |
Accepting new patients |
| Visionworks, Inc | Current |
Accepting new patients | |
| America'S Best Contacts & Eyeglasses | Past | Accepting new patients |
Locations
16025 W Bluemound Rd
Brookfield, WI 53005
Phone (262) 785-0490
4800 Golf Rd
Ste 436
Eau Claire, WI 54701
Phone (715) 834-8404
2500 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 453-2315
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 353735 | WI | Yes |
Addresses
Primary practice location
8661 S Howell Ave Ste 200
Oak Creek, WI 53154-2919
Mailing address
860 Weidner Rd Apt 502
Buffalo Grove, IL 60089-4753
Phone (440) 212-6885
Other providers in Oak Creek, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2019. 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.