Great Lakes Family Vision SC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

2716035 Issued in WI

Legal business name

GREAT LAKES FAMILY VISION SC

Practice address

289 E Green Bay Ave
Saukville, WI 53080-2006

Phone

(262) 268-2007

Fax

(262) 268-8257

NPI assigned

Oct 30, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Stuart Wade Natale, O.D.NPI 1427116375

Title

Owner/ Optometrist

Phone

(262) 268-2007

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stuart W Natale, OD

  • Optometrist
  • Saukville, WI
  • NPI 1427116375
  Medicare reassignment NPD Authorized official
• Eric Paul Pedersen, OD

  • Optometrist
  • Fredonia, WI
  • NPI 1992793806
  Medicare reassignment NPD

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

{
    "created_epoch": "1256860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260489600000",
    "number": "1437485125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "289 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802006",
            "telephone_number": "262-268-2007",
            "fax_number": "262-268-8257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 E GREEN BAY AVE",
            "city": "SAUKVILLE",
            "state": "WI",
            "postal_code": "530802006",
            "telephone_number": "262-268-2007",
            "fax_number": "262-268-8257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES FAMILY VISION SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-30",
        "last_updated": "2009-12-11",
        "status": "A",
        "authorized_official_last_name": "NATALE",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "OWNER/ OPTOMETRIST",
        "authorized_official_telephone_number": "262-268-2007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WI",
            "license": "2716035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Foust, PHARM D
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• David Grandinetti
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• Knutson
• Sarah A Locke, APNP
• Gina Lynn Lusis, RPH
• George Stephen Mann III, PT

• Eyewear Supplier in Saukville, WI
• Providers in Saukville, WI by specialty
• Eyewear Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.