Kristen K Dorman, O.D.
Individual provider Active NPI Optometrist · Fredonia, WI
NPI 1609833110 · NPPES record last updated Mar 12, 2020
Key facts
- NPI
- 1609833110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2673-035 (WI)
- Practice address
- 120 Martin Dr
Fredonia, WI 53021-9455 - Phone
- (262) 692-9000
- Fax
- (262) 692-2797
- NPI assigned
- Apr 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 20
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advanced Focus Eyecare LLC
Shoptikal LLC
Schuster Family Eyecare LLC
Practice addresses (Care Compare)
1116 N Main St
West Bend, WI 53090-1923
Phone (262) 247-2343
1166 W Sunset Dr
Suite F100
Waukesha, WI 53189-8441
Phone (262) 574-9410
W162N9235 Pershing Ave
Menomonee Falls, WI 53051-4026
Phone (262) 946-6075
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070417000305 | WI | Practitioner - Optometry | 9638274814 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2673-035 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Wisconsin, LLC | Optometrist | Current | Accepting new patients |
| Advanced Focus Eyecare LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Wisconsin, LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Wisconsin, LLC | Optometrist | Current |
Accepting new patients |
| Schuster Family Eyecare LLC | Optometrist | Current |
Accepting new patients |
| Shopko Stores Operating Co LLC | Past | Accepting new patients | |
| Medical Eye Associates, S.C. | Past | Accepting new patients | |
| Medical Eye Associates, S.C. | Past |
Accepting new patients |
Locations
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
120 Martin Dr
Fredonia, WI 53021
Phone (262) 692-9000
535 S Monroe Ave
Green Bay, WI 54301
Phone (920) 435-9511
2305 30th Ave
Kenosha, WI 53144
Phone (262) 597-2020
W162N9235 Pershing Ave
Menomonee Fls, WI 53051
Phone (262) 946-6070
N78W14573 Appleton Ave
Menomonee Fls, WI 53051
Phone (262) 207-4701
15300 W Grange Ave
New Berlin, WI 53151
Phone (262) 599-7040
1116 N Main St
West Bend, WI 53090
Phone (262) 247-2343
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2673-035 | WI | Yes |
Addresses
Primary practice location
120 Martin Dr
Fredonia, WI 53021-9455
Mailing address
1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899
Other practice location 1
1111 Delafield St
Suite 312
Waukesha, WI 53188-3417
Phone (262) 547-3352
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 822601 | Other | WI | VIPA |
| 38608200 | Other | WI | WI HEALTH INS RSK SHAR PR |
| 391101335 | Other | WI | WI PHYS SERV WPS |
| 410041553 | Other | WI | RAILROAD MEDICARE |
| 5300133 | Other | WI | AETNA |
| 38608200 | Other | WI | ABRI |
| 103436 | Other | WI | HEALTH ALLIANCE |
| 747042 | Other | WI | MOHAWK |
| 38608200 | Medicaid | WI |
Other providers in Fredonia, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2020. 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.
- Order and Referring (CMS).
- 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.