NPIMap

Organization Active NPI

Family Vision & Contact Lens CTRS SC

  • Optometrist
  • Mukwonago, WI
National Provider Identifier
1376718536
Registry record updated Apr 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
FAMILY VISION & CONTACT LENS CTRS SC
Practice address
920 Greenwald CT
Suite 300
Mukwonago, WI 53149-1711
Phone
(262) 363-1717
Fax
(262) 363-1726
NPI assigned
Apr 28, 2008
Last updated
Apr 9, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY VISION & CONTACT LENS CTRS SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2012

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

Authorized official

Name
Dr. Robert Lawrence Fait, ODNPI 1972548386
Title
Owner
Phone
(262) 763-0117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

920 Greenwald CT
Suite 300
Mukwonago, WI 53149-1711

Mailing address

PO Box 630
309 McHenry St
Burlington, WI 53105
Phone (262) 763-0117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930017969 WI DME Supplier - Physician - Optometrist 9133135734 Practice locations: Mukwonago, WI

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Family Vision & Contact Lens Center920 Greenwald CT 300, Mukwonago, WI 53149-1754(262) 363-1717 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2000

National Provider Directory

National Provider Directory
Tax ID family
David M Ebley OD5 organizations share this tax ID, including this one
Part of
David M Ebley OD

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1376718536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 630",
            "address_2": "309 MCHENRY ST",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "53105",
            "telephone_number": "262-763-0117",
            "fax_number": "262-763-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 GREENWALD CT",
            "address_2": "SUITE 300",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531491711",
            "telephone_number": "262-363-1717",
            "fax_number": "262-363-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY VISION & CONTACT LENS CTRS SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY VISION & CONTACT LENS CTRS SC",
        "enumeration_date": "2008-04-28",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "FAIT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-763-0117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mukwonago, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.