Lake Country Eye Care, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2878-035 Issued in WI

Legal business name

LAKE COUNTRY EYE CARE, LLC

Practice address

520 Hartbrook Dr Ste F
Hartland, WI 53029-1402

Phone

(262) 367-6610

Fax

(262) 367-0964

NPI assigned

Nov 5, 2014

Last updated

Jun 30, 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. Amber A Dentz, O.D.NPI 1548339096

Title

Optometrist/Owner

Phone

(262) 367-6610

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 6

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.

• Amber A. Dentz, O.D.

  • Optometrist
  • Hartland, WI
  • NPI 1548339096
  Medicare reassignment Care Compare group NPD Authorized official
• Andrew J Baldus, O.D.

  • Optometrist
  • West Bend, WI
  • NPI 1316924590
  Medicare reassignment Care Compare group NPD
• Joel Hansen, OD

  • Optometrist
  • West Allis, WI
  • NPI 1598324154
  Medicare reassignment Care Compare group NPD
• Ashlee Finnell, OD

  • Optometrist
  • Manning, SC
  • NPI 1053806372

  WI

  Medicare reassignment Care Compare group NPD
• Christopher R Winter, O.D.

  • Optometrist
  • Sussex, WI
  • NPI 1023159324
  Medicare reassignment Care Compare group
• Bartlomiej Celer, OD

  • Optometrist
  • Pewaukee, WI
  • NPI 1790459758
  Medicare reassignment NPD

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1457757288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 HARTBROOK DR STE F",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530291402",
            "telephone_number": "262-367-6610",
            "fax_number": "262-367-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 HARTBROOK DR STE F",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530291402",
            "telephone_number": "262-367-6610",
            "fax_number": "262-367-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-05",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "DENTZ",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "262-367-6610",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2878-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152WOOOOX",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11533287",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Marie Kretlow
• Krin Kramer Psychotherapy
• Kyle David Krueger, DDS
• Karin I Kultgen, M.D.
• David Paul Labs, RPH
• Lake Country Neurology and Spine Center
• Lake Country Therapist (Lake Country Therapy)
• Gabriele H Langan, PT
• Sean Davis Laroque, PH.D.
• Bethany Lato, LPC-IT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.