Advanced Family Eyecare

Primary specialty

OptometristTaxonomy code 152W00000X

License

2753 Issued in WI

Legal business name

ADVANCED FAMILY EYECARE

Practice address

308 W Fulton St
Waupaca, WI 54981-1422

Phone

(715) 258-8168

Fax

(715) 258-8436

NPI assigned

Nov 1, 2006

Last updated

Jul 18, 2011By 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

Dr. Daniel R Everts, ODNPI 1811968878

Title

Owner/President

Phone

(715) 258-8168

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Daniel R Everts, OD

  • Optometrist
  • Waupaca, WI
  • NPI 1811968878
  Medicare reassignment Care Compare group NPD Authorized official
• Cody W Dagnall, OD

  • Optometrist
  • Waupaca, WI
  • NPI 1851036867
  Medicare reassignment Care Compare group NPD
• Jake Pray, OD

  • Optometrist
  • Walhalla, SC
  • NPI 1508392465

  WI

  Medicare reassignment NPD

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1578640223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 W FULTON ST",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811422",
            "telephone_number": "715-258-8168",
            "fax_number": "715-258-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 W FULTON ST",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811422",
            "telephone_number": "715-258-8168",
            "fax_number": "715-258-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FAMILY EYECARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "EVERTS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "715-258-8168",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38716100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Helen Adams, RN
• Tracy J Adams, RN
• Anita Ahlborn
• Syed M Ala, MD
• Angela Kaye Amos, MD
• Sarah Rose Andersen
• Catherine A Anderson, APNP

• Optometrist in Waupaca, WI
• Providers in Waupaca, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; 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.