Active NPI
Herslof's, Inc
Doing business as Lincoln Park Optical
- Optician
- Kenosha, WI
National Provider Identifier
1467581942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- Legal business name
- HERSLOF'S, INC
- Doing business as
- Lincoln Park Optical
- Practice address
- 2120 63Rd St
Kenosha, WI 53143-4454 - Phone
- (262) 605-0931
- NPI assigned
- Mar 2, 2007
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Vicki Dickman
- Title
- VP
- Phone
- (414) 462-1300
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | NU | Primary |
Addresses
Primary practice location
2120 63Rd St
Kenosha, WI 53143-4454
Mailing address
12000 W Carmen Ave
Milwaukee, WI 53225-2116
Phone (414) 462-1300
Other names 1
- LINCOLN PARK OPTICAL
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040211000238 | WI | Part B Supplier - Clinic/Group Practice | 4789578782 |
Receives reassigned benefits from 11 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Milwaukee, WI; West Bend, WI; New Berlin, WI; Oconomowoc, WI; Pewaukee, WI; Racine, WI; Saukville, WI; Sheboygan, WI… |
Other NPIs on the same Medicare enrollment 15
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Herslof Opticians
Other organizations with this tax ID 24
Organizations that report the same tax identification number in the National Provider Directory.
Locations
2120 63rd St
Kenosha, WI 53143
Phone (262) 605-0931
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1467581942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12000 W CARMEN AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532252116",
"telephone_number": "414-462-1300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 63RD ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531434454",
"telephone_number": "262-605-0931"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HERSLOF'S, INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-02",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "DICKMAN",
"authorized_official_first_name": "VICKI",
"authorized_official_title_or_position": "VP",
"authorized_official_telephone_number": "414-462-1300"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "LINCOLN PARK OPTICAL",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.