Eye Clinic of Wisconsin SC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

EYE CLINIC OF WISCONSIN SC

Practice address

409 N Chestnut Ave
Marshfield, WI 54449-2000

Phone

(715) 261-8557

NPI assigned

Sep 2, 2022

Last updated

Sep 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Goddard

Title

Administrator

Phone

(715) 261-8557

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Eye Clinic of Wisconsin SC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Eye Clinic of Wisconsin SC

  • Ophthalmology Physician
  • Wausau, WI
  • NPI 1740263458
  NPD tax ID
• Eye Clinic of Wisconsin, S.C.

  • Ophthalmology Physician
  • Antigo, WI
  • NPI 1740264266
  NPD tax ID
• Eye Clinic of Wisconsin, S.C.

  • Ophthalmology Physician
  • Stevens Point, WI
  • NPI 1962485615
  NPD tax ID
• Eye Clinic of Wisconsin, SC

  • Ophthalmology Physician
  • Wisconsin Rapids, WI
  • NPI 1114315587
  NPD tax ID

Practitioners 1

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.

• Connor William Monaghan, OD

  • Optometrist
  • Cleveland, OH
  • NPI 1437847589
  NPD (past)

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

{
    "created_epoch": "1662076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1558081000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N 1ST ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544034754",
            "telephone_number": "715-261-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 N CHESTNUT AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544492000",
            "telephone_number": "715-261-8557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CLINIC OF WISCONSIN SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-02",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A",
        "authorized_official_last_name": "GODDARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-261-8557"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32667800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Elizabeth Evans, PHARMD
• Paul M Evans, PHARMD
• Hannah Nicole Everson, CRNA
• Everspring Counseling LLC
• Brian H Ewert, MD
• Eye Wear Designs of Marshfield LLC
• Patricia K Faber, MSW
• Olubukola Fagbemi
• Seth Fagbemi, MD
• Dean Fait, OD

• Ophthalmology Physician in Marshfield, WI
• Providers in Marshfield, WI by specialty
• Ophthalmology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.