Michael Desmond Main, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3021-035 Issued in WI

Practice address

1220 Parkwood Dr
Wisconsin Rapids, WI 54494-5488

Phone

(715) 421-2111

Fax

(715) 421-2123

NPI assigned

Jun 14, 2006

Last updated

May 24, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • Kenosha, WI
  • NPI 1164992996
  Medicare reassignment NPD
• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • Wauwatosa, WI
  • NPI 1154939288
  NPD
• Myeyedr Optometry of Wisconsin, LLC

  dba MyEyeDr.

  • Optometrist
  • West Allis, WI
  • NPI 1710632864
  NPD

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1386687333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "517-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 PARKWOOD DR",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544945488",
            "telephone_number": "715-421-2111",
            "fax_number": "715-421-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIN",
        "first_name": "MICHAEL",
        "middle_name": "DESMOND",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3021-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynja Inc (Daly Drug Long Term Care Pharmacy)
• Diane Maciejewski
• Kheson Kaballa Madison
• William Mahoney V, PHARMD
• Carol Ann Sheker Main, OD
• Jacob George Malooly, PA-C
• Matthew Harold Malooly, PHARM.D.
• Kathryn Mann
• Bethany Lynn Marceau, COTA
• Marshfield Clinic (Marshfield Clinic Wisconsin Rapids Orthopedic Center)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.