Vita Park Eye Associates, SC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

VITA PARK EYE ASSOCIATES, SC

Doing business as

The Beaver Dam Eye Clinic

Practice address

240 Corporate Drive
Beaver Dam, WI 53916-3115

Phone

(920) 887-1151

Fax

(920) 887-3353

NPI assigned

Jul 15, 2006

Organization subpart

Yes

Parent organization

VITA PARK EYE ASSOCIATES, SCAs reported in NPPES

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

Authorized official

Name

Thomas Castillo, DO

Title

Corporation Officer

Phone

(920) 887-1151

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• The Beaver Dam Eye Clinic Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Vita Park Eye Associates SC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Vita Park Eye Associates, SC

  • Ophthalmology Physician
  • Beaver Dam, WI
  • NPI 1154418051
  NPPES parent name

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1447276894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 CORPORATE DR",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163115",
            "telephone_number": "920-887-1151",
            "fax_number": "920-887-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 CORPORATE DRIVE",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163115",
            "telephone_number": "920-887-1151",
            "fax_number": "920-887-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITA PARK EYE ASSOCIATES, SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VITA PARK EYE ASSOCIATES, SC",
        "enumeration_date": "2006-07-15",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CORPORATION OFFICER",
        "authorized_official_telephone_number": "920-887-1151",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPMOS SUPPLIER",
            "identifier": "0593830002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE LOCATION",
            "identifier": "000016160",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CP765",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21310700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN CARE HMO LOCATION",
            "identifier": "519075",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Beaver Dam Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Beaver Dam Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vein Care Associates S.C.
• Prabhu Venkataraman, LPC-IT
• Victor W. Caceres, M.D.,S.C.
• Lynda K Vielbig, CRNA
• Vita Park Eye Associates, SC
• Katherine M Volz, PT, DPT
• Vop Beaver Dam, LLC (Dimensions Living Beaver Dam)
• Lindsey Joann Wagner-Hron, LCSW, CSAC
• Kellie Marie Wagner, PT, DPT, CSCS
• Serena Wagoner, DO

• Ophthalmology Physician in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Ophthalmology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.