Osceola Family Eyecare LLC
Organization Active NPI Optometrist · Osceola, WI
NPI 1578865747 · NPPES record last updated Jan 2, 2012
Key facts
- NPI
- 1578865747
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- WI2728 (WI)
- Legal business name
- OSCEOLA FAMILY EYECARE LLC
- Practice address
- 304 3Rd Ave
Osceola, WI 54020 - Phone
- (715) 294-2500
- Fax
- (715) 294-3466
- NPI assigned
- Nov 22, 2010
- Organization subpart
- No
Authorized official
- Name
- Brian D Smith, OD
- Title
- Owner
- Phone
- (715) 294-2500
Practitioners 3
-
Brian Darrell Smith, O.D.
-
Micki Maureen Flynn, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Osceola Family Eyecare LLC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110425000230 | WI | Part B Supplier - Clinic/Group Practice | 5991980633 |
Receives reassigned benefits from 2 practitioners Practice locations: Osceola, WI |
| O20110811000625 | WI | DME Supplier - Physician - Optometrist | 5991980633 | Practice locations: Osceola, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | WI2728 | WI | Yes |
Addresses
Primary practice location
304 3Rd Ave
Osceola, WI 54020
Mailing address
PO Box 386
Osceola, WI 54020-0386
Phone (715) 294-2500
Other names
- Osceola Family Eyecare
Other providers in Osceola, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2012. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.