Individual provider Active NPI

Emma Elizabeth Letlebo, OD

  • Optometrist
  • Verona, WI
National Provider Identifier
1609357359
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3577-035 Issued in WI
Practice address
320 S Main St
Verona, WI 53593-1424
Phone
(608) 848-5168
NPI assigned
Aug 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3485 TN
Optometrist 152W00000X 3577-035 WI Primary

Addresses

Primary practice location

320 S Main St
Verona, WI 53593-1424

Mailing address

1245 Madison Ave
Memphis, TN 38104-2211

Other practice location 1

1225 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191016001234 WI Practitioner - Optometry 7719222934 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Verona Vision Care LLCGroup PAC ID 2163423484, 4 clinicians

Practice addresses (Care Compare)

320 S Main St
Verona, WI 53593-1424
Phone (608) 848-5168

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3577-035WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Verona Vision Care, LLC Optometrist CurrentSince Sep 25, 2019 Accepting new patients

Locations

320 S Main St
Verona, WI 53593
Phone (608) 848-5168

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1609357359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S MAIN ST",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535931424",
            "telephone_number": "608-848-5168"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381042211",
            "country_code": "US",
            "telephone_number": "901-722-3250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LETLEBO",
        "first_name": "EMMA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3485",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3577-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Verona, WI

Sources for this page

Verify at the official NPI Registry.