Amanda C Lallensack, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3700 Issued in WI

Practice address

8201 Mish Ko Swen Dr
Crandon, WI 54520-8631

Phone

(715) 478-4300

NPI assigned

Jun 8, 2020

Last updated

Aug 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Forest County Potawatomi CommunityGroup PAC ID 3375454689, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.lallensack.1@8439.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Forest County Potawatomi Community

  dba Potawatomi Health & Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Crandon, WI
  • NPI 1285741306
  Medicare reassignment Care Compare group NPD
• Albuquerque Indian Health Center

  • Clinic/Center
  • Albuquerque, NM
  • NPI 1659458917

  TX

  Medicare reassignment NPD
• Santa Ana Health Center

  • Health Service Clinic/Center
  • Bernalillo, NM
  • NPI 1649331323

  TX

  Medicare reassignment NPD
• Morrison Eye Clinic, SC

  • Optometrist
  • Delavan, WI
  • NPI 1730370826
  NPD (past)

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1477178259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 396",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545200396",
            "telephone_number": "715-478-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 MISH KO SWEN DR",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208631",
            "telephone_number": "715-478-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALLENSACK",
        "first_name": "AMANDA",
        "middle_name": "C",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-08",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Kircher, RN
• Linda F Kortbein, RN
• Aaron Krause, PT
• Jennifer Krzmarcik, SAC-IT
• Amy Susan Kuebler, APNP
• Jessica Linderud, PHARMD
• Dakota Ann Malzewski, DC
• Frederick A Mathwig, PT
• Lynette M McCorkle, LPC
• Laura L Meverden, APNP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.