Eye & Vision Clinics, S.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1428 Issued in WI

Legal business name

EYE & VISION CLINICS, S.C.

Practice address

140 School Creek TRL
Luxemburg, WI 54217-1095

Phone

(920) 845-5555

Fax

(920) 845-5219

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Jennifer Potts

Title

Clinic Manager

Phone

(920) 845-5555

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Eye & Vision Clinics, S.C.

  • Optometrist
  • De Pere, WI
  • NPI 1881711588

  7911965165

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Eye & Vision Clinics, S.C.

  • Optometrist
  • De Pere, WI
  • NPI 1881711588

  O20041221000050

  Same enrollment

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

Medicare medical equipment & supply locations

Locations

Practitioners 2

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

• Tyler Mazur, OD

  • Optometrist
  • Minnetonka, MN
  • NPI 1932683281
  NPD
• Matthew L. Nelson, O.D.

  • Optometrist
  • De Pere, WI
  • NPI 1194812099
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1447377148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SCHOOL CREEK TRL",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171095",
            "telephone_number": "920-845-5555",
            "fax_number": "920-845-5219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SCHOOL CREEK TRL",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171095",
            "telephone_number": "920-845-5555",
            "fax_number": "920-845-5219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE & VISION CLINICS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "POTTS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "920-845-5555"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR MATTHEW L NELSON",
            "identifier": "1194812099",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR DAVID R DUFECK",
            "identifier": "1003927278",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR TIMOTHY J CORGAN",
            "identifier": "1790731743",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR DEPERE CLINIC",
            "identifier": "1881711588",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guy Dawalt, DC
• Samantha J Dawalt, DC
• Ann Marie Deprey, M.S., CCC-SLP
• Gina Enderby
• Elyse Marie Engebose, FNP-C
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• Rey Anthony G Garibay, MD
• Amanda Haberli, RN
• Helping Hearts Assisted Living LLC
• Bonnie L Hert

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.