Active NPI
John E Hall
- Optometrist
- Elkhorn, WI
National Provider Identifier
1376575423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1349
- Practice address
- 419 N Wisconsin St
Elkhorn, WI 53121-1317 - Phone
- (262) 723-2234
- Fax
- (226) 723-2834
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1349 | WI | Primary |
| Optometrist | 152W00000X | 046006337 | IL |
Addresses
Primary practice location
419 N Wisconsin St
Elkhorn, WI 53121-1317
Mailing address
PO Box 350
Elkhorn, WI 53121-0350
Phone (262) 723-2234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38571300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110107000653 | WI | Practitioner - Optometry | 0941311021 | Practice locations: Elkhorn, WI |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1969
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
419 N Wisconsin St
Elkhorn, WI 53121-1317
Phone (262) 723-2234
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046006337 | IL | MD | Optometrist |
| 1349 | WI | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236902400000",
"number": "1376575423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 350",
"city": "ELKHORN",
"state": "WI",
"postal_code": "531210350",
"telephone_number": "262-723-2234",
"fax_number": "226-723-2834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 N WISCONSIN ST",
"city": "ELKHORN",
"state": "WI",
"postal_code": "531211317",
"telephone_number": "262-723-2234",
"fax_number": "226-723-2834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "JOHN",
"middle_name": "E",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2009-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1349",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046006337",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38571300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhorn, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.