NPIMap

Organization Active NPI

I C 20 20 Eau Claire Inc

  • Eyewear Supplier
  • Eau Claire, WI
National Provider Identifier
1487710539
Registry record updated Jan 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
2275035 Issued in WI
Legal business name
I C 20 20 EAU CLAIRE INC
Practice address
4054 Commonwealth Ave
Eau Claire, WI 54701-9000
Phone
(715) 833-1220
Fax
(715) 833-1297
NPI assigned
Dec 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2014

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

Authorized official

Name
John DelakisNPI 1790949055
Title
Owner Manager
Phone
(715) 833-1220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 2275035 WI Primary

Addresses

Primary practice location

4054 Commonwealth Ave
Eau Claire, WI 54701-9000

Mailing address

4054 Commonwealth Ave
Eau Claire, WI 54701-9000
Phone (715) 833-1220

Other identifiers 1

IdentifierTypeStateIssuer
38711700MedicaidWI

Other names 1

  • Sterling Optical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071129000228 WI Part B Supplier - Clinic/Group Practice 7719076777 Receives reassigned benefits from 2 practitioners
Practice locations: Eau Claire, WI
O20100930004757 WI DME Supplier - Physician - OptometristDME Supplier - Optician 7719076777 Practice locations: Eau Claire, WI

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Sterling Optical4054 Commonwealth Ave, Eau Claire, WI 54701-9000(715) 833-1220 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1999

National Provider Directory

National Provider Directory

Locations

3402 13th Ave S
Ste D
Fargo, ND 58103
Phone (701) 234-0939

3120 25th St S
Fargo, ND 58103

4054 Commonwealth Ave
Eau Claire, WI 54701
Phone (715) 833-1220

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1167436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389830400000",
    "number": "1487710539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4054 COMMONWEALTH AVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547019000",
            "telephone_number": "715-833-1220",
            "fax_number": "715-833-1297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4054 COMMONWEALTH AVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547019000",
            "telephone_number": "715-833-1220",
            "fax_number": "715-833-1297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I C 20 20 EAU CLAIRE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-30",
        "last_updated": "2014-01-16",
        "status": "A",
        "authorized_official_last_name": "DELAKIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER MANAGER",
        "authorized_official_telephone_number": "715-833-1220"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "WI",
            "license": "2275035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38711700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sterling Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eau Claire, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; 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.