Active NPI
Brad Harold Ewald, O.D.
- Optometrist
- Rice Lake, WI
National Provider Identifier
1396863387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1347-035
- Practice address
- 2900 S Main St
Rice Lake, WI 54868 - Phone
- (715) 234-1511
- Fax
- (715) 434-1513
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- 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 | 1347-035 | WI | Primary |
Addresses
Primary practice location
2900 S Main St
Rice Lake, WI 54868
Mailing address
2900 S Main St
Rice Lake, WI 54868
Phone (715) 234-1511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1347-035 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tarpenning & Associates | Optometrist | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228780800000",
"number": "1396863387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 S MAIN ST",
"city": "RICE LAKE",
"state": "WI",
"postal_code": "54868",
"telephone_number": "715-234-1511",
"fax_number": "715-434-1513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 S MAIN ST",
"city": "RICE LAKE",
"state": "WI",
"postal_code": "54868",
"telephone_number": "715-234-1511",
"fax_number": "715-434-1513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWALD",
"first_name": "BRAD",
"middle_name": "HAROLD",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2008-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1347-035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rice Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.