NPIMap

Organization Active NPI

Chippewa Valley Eye Clinic Chippewa Falls SC

  • Ophthalmologic Surgery Clinic/Center
  • Chippewa Falls, WI
National Provider Identifier
1487710638
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmologic Surgery Clinic/CenterTaxonomy code 261QS0132X
Legal business name
CHIPPEWA VALLEY EYE CLINIC CHIPPEWA FALLS SC
Practice address
2525 County Highway I
Chippewa Falls, WI 54741
Phone
(715) 723-9375
Fax
(715) 723-1092
NPI assigned
Dec 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Peter W HolmNPI 1295844983
Title
President
Phone
(715) 723-9375

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmologic Surgery Clinic/Center 261QS0132X Primary

Addresses

Primary practice location

2525 County Highway I
Chippewa Falls, WI 54741

Mailing address

2525 County Highway I
Chippewa Falls, WI 54729
Phone (715) 723-9375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100310000179 WI Part B Supplier - Clinic/Group Practice 0446395800 Receives reassigned benefits from 5 practitioners
Practice locations: Chippewa Falls, WI; Stanley, WI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Chippewa Valley Eye Clinic Chippewa Falls SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2525 County Highway I
Chippewa Fls, WI 54729
Phone (715) 723-6520

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487710638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 COUNTY HIGHWAY I",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "54729",
            "telephone_number": "715-723-9375",
            "fax_number": "715-723-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 COUNTY HIGHWAY I",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "54741",
            "telephone_number": "715-723-9375",
            "fax_number": "715-723-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIPPEWA VALLEY EYE CLINIC CHIPPEWA FALLS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLM",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-723-9375"
    },
    "taxonomies": [
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chippewa Falls, 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.

Verify at the official NPI Registry.