Active NPI
Inger L Gibson, OD
- Optometrist
- Lake Geneva, WI
National Provider Identifier
1386637007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2495
- Practice address
- 154 E Geneva SQ
Lake Geneva, WI 53147-9694 - Phone
- (262) 249-1000
- Fax
- (262) 249-1255
- NPI assigned
- Aug 29, 2005
- Sex
- Female
- Sole proprietor
- No
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 | 2495 | WI | Primary |
Addresses
Primary practice location
154 E Geneva SQ
Lake Geneva, WI 53147-9694
Mailing address
154 E Geneva SQ
Lake Geneva, WI 53147-9694
Phone (262) 249-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38618100 | 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
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1991
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
154 E Geneva SQ
Lake Geneva, WI 53147-9694
Phone (262) 249-1000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Eyecare & Contact Lens Center, LLC | Optometrist | Current | Accepting new patients |
Locations
154 E Geneva Sq
Lake Geneva, WI 53147
Phone (262) 249-1000
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Lake Geneva, WI
- NPI 1780848523
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210809600000",
"number": "1386637007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "154 E GENEVA SQ",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531479694",
"telephone_number": "262-249-1000",
"fax_number": "262-249-1255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "154 E GENEVA SQ",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531479694",
"telephone_number": "262-249-1000",
"fax_number": "262-249-1255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "INGER",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-29",
"last_updated": "2008-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "2495",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38618100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Geneva, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.