Herman Advanced Family Eyecare
Organization Active NPI Optometrist · Chetek, WI
NPI 1497953632 · NPPES record last updated Mar 16, 2011
Key facts
- NPI
- 1497953632
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 3031 (WI)
- Legal business name
- HERMAN ADVANCED FAMILY EYECARE
- Practice address
- 510 2ND St
Chetek, WI 54728-9009 - Phone
- (715) 924-3660
- Fax
- (715) 924-3937
- NPI assigned
- Jul 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Karen Herman, OD
- Title
- Owner
- Phone
- (715) 568-1373
Other NPIs on the same Medicare enrollment 1
Practitioners 2
-
Karen Lee Herman, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050924000077 | WI | Part B Supplier - Clinic/Group Practice | 0749214195 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bloomer, WI; Chetek, WI |
National Provider Directory
Locations
1111 15th Ave
Bloomer, WI 54724
Phone (715) 568-1373
712 2nd St
Chetek, WI 54728
Phone (715) 924-3660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 3031 | WI | Yes |
Addresses
Primary practice location
510 2ND St
Chetek, WI 54728-9009
Mailing address
510 2ND St
PO Box 336
Chetek, WI 54728-9009
Phone (715) 924-3660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38723600 | Medicaid | WI |
Other providers in Chetek, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.