Community Eyecare Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

2676 Issued in WI

Legal business name

COMMUNITY EYECARE INC

Practice address

413 S Main St
Black Creek, WI 54106-9501

Phone

(920) 722-6872

Fax

(920) 722-6335

NPI assigned

Mar 20, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Gwen E Schreiber

Title

Manager

Phone

(920) 722-6872

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Community Eyecare Inc

  • Optometrist
  • Brillion, WI
  • NPI 1548457757

  O20041123000016

  Same enrollment
• Community Eyecare Inc

  • Optometrist
  • Menasha, WI
  • NPI 1861463234

  O20041123000016

  Same enrollment

Locations

Practitioners 2

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

• Charles J Burgess, OD

  • Optometrist
  • Menasha, WI
  • NPI 1699768333
  NPD
• Nathan Michael Larson, OD

  • Optometrist
  • Menasha, WI
  • NPI 1073207445
  NPD

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332201600000",
    "number": "1528333788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 APPLETON RD",
            "address_2": "PO BOX 534",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521501",
            "telephone_number": "920-722-6872",
            "fax_number": "920-722-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 S MAIN ST",
            "city": "BLACK CREEK",
            "state": "WI",
            "postal_code": "541069501",
            "telephone_number": "920-722-6872",
            "fax_number": "920-722-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY EYECARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-20",
        "last_updated": "2012-03-20",
        "status": "A",
        "authorized_official_last_name": "SCHREIBER",
        "authorized_official_first_name": "GWEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "920-722-6872",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlie James Aschenbach, RN
• Black Creek Chiropractic Office LLC
• Black Creek Dental LLC
• Black Creek Rescue Service
• Traci Rae Bloedorn, ARCB
• Michelle Leanne Draheim, RN
• Caitlin Ebben, RN
• Kayla Ann Ebben, RN
• Empower Her Therapy
• Michael Faudree, MD

• Optometrist in Black Creek, WI
• Providers in Black Creek, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; 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.