Oconomowoc Vision Clinic, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3017 Issued in WI

Legal business name

OCONOMOWOC VISION CLINIC, LLC

Practice address

1674 Old Schoolhouse Rd
Suite 101
Oconomowoc, WI 53066-1396

Phone

(262) 567-2295

Fax

(262) 567-0744

NPI assigned

Nov 18, 2007

Last updated

May 10, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Mark Bjork, O.D.NPI 1487726535

Title

Owner/Optometrist

Phone

(262) 567-2295

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

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

Locations

Practitioners 5

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.

• David Bjork, O.D.

  • Optometrist
  • Oconomowoc, WI
  • NPI 1487726535
  Medicare reassignment Care Compare group Authorized official
• Macie Brahm, OD

  • Optometrist
  • Oconomowoc, WI
  • NPI 1831931914
  Medicare reassignment Care Compare group NPD
• McKenna Rae Young, OD

  • Optometrist
  • Pewaukee, WI
  • NPI 1952039349
  Medicare reassignment
• James Joseph Baietto, OD

  • Optometrist
  • Oconomowoc, WI
  • NPI 1265401624
  NPD (past)
• Erik R Bjork, O.D

  • Optometrist
  • Oconomowoc, WI
  • NPI 1962453589
  NPD (past)

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

{
    "created_epoch": "1195344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368144000000",
    "number": "1376724377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1674 OLD SCHOOLHOUSE RD",
            "address_2": "SUITE 101",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530661396",
            "telephone_number": "262-567-2295",
            "fax_number": "262-567-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1674 OLD SCHOOLHOUSE RD",
            "address_2": "SUITE 101",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530661396",
            "telephone_number": "262-567-2295",
            "fax_number": "262-567-0744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCONOMOWOC VISION CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-18",
        "last_updated": "2013-05-10",
        "status": "A",
        "authorized_official_last_name": "BJORK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "262-567-2295",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38726800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1487726535",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; 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.