Wolf River Eyecare LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2483-035 Issued in WI

Legal business name

WOLF RIVER EYECARE LLC

Practice address

1923 N Shawano St
Suite B
New London, WI 54961-7510

Phone

(920) 982-4561

Fax

(920) 982-9811

NPI assigned

Oct 3, 2006

Last updated

Jul 7, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Paul K Thompson, O.D.

Title

Owner

Phone

(920) 982-4561

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rebecca D Amaral, O.D.

  • Optometrist
  • New London, WI
  • NPI 1114013943
  Medicare reassignment NPD

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436227200000",
    "number": "1447344593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 N SHAWANO ST",
            "address_2": "SUITE B",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549617510",
            "telephone_number": "920-982-4561",
            "fax_number": "920-982-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 N SHAWANO ST",
            "address_2": "SUITE B",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549617510",
            "telephone_number": "920-982-4561",
            "fax_number": "920-982-9811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLF RIVER EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2015-07-07",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-982-4561",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2752-035",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2483-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38719600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey C Weyenberg
• Sharon Marie Wichlacz, RN
• Amber Lievens Widenski, D.O.
• Shawn S Williamson, M.D.
• Warren Adam Witkowski, D.C.
• Emily Ann Wolfe
• Trina Marie Wurster, OTR
• Simon Richard Yadgir
• Carolyn Zabor, PA
• Summer Ria Zadra

• Optometrist in New London, WI
• Providers in New London, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; 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.