Antigo Eye Care Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

T61453 Issued in WI

Legal business name

ANTIGO EYE CARE CENTER

Practice address

810 5TH Ave
Antigo, WI 54409-1937

Phone

(715) 623-3620

Fax

(715) 623-3333

NPI assigned

Sep 20, 2006

Last updated

Jul 10, 2008By 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

Mary Kay Bartlette

Title

Office Manager

Phone

(715) 623-3620

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Gregory Lee Leischer, O.D.

  • Optometrist
  • Wausau, WI
  • NPI 1285770065
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1457459836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 5TH AVE",
            "address_2": "P O BOX 628",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544091937",
            "telephone_number": "715-623-3620",
            "fax_number": "715-623-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 5TH AVE",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544091937",
            "telephone_number": "715-623-3620",
            "fax_number": "715-623-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIGO EYE CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "BARTLETTE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "715-623-3620"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "T61453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38708600-38553700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark A Aldrich, DPM
• Brennen Anderson
• Todd E. Anderson, C.R.N.A.
• Antigo Chiropractic Health Center, Inc (Goldsworthy Chiropractic)
• Antigo Dental Clinic L.L.C.
• Antigo Family Chiropractic Center LLC
• Antigo Medical Building, LLC
• Antigo Total Therapy & Sports Rehab Center Inc
• Antigo Vans LLC
• Antigo Vision Clinic SC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.

Verify at the official NPI Registry.