Individual provider Active NPI

Renee Haefs, O.D.

  • Optometrist
  • Mequon, WI
National Provider Identifier
1609883990
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2698 Issued in WI
Practice address
10938 N Port Washington Rd
Mequon, WI 53092-5031
Phone
(262) 241-4848
Fax
(262) 241-9865
NPI assigned
Aug 1, 2006
Last updated
Oct 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2698 WI Primary

Addresses

Primary practice location

10938 N Port Washington Rd
Mequon, WI 53092-5031

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other practice location 1

5102 S Packard Ave
Cudahy, WI 53110-1922
Phone (414) 769-6120

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
I20050822000240 WI Practitioner - Optometry 5092745836 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2698WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Wisconsin, LLC Optometrist Current Accepting new patients
Watertown Physician Practices LLC CurrentSince Oct 27, 2020 Accepting new patients
Myeyedr Optometry of Wisconsin, LLC Optometrist CurrentSince Sep 14, 2020 Accepting new patients
Myeyedr Optometry of Wisconsin, LLC Optometrist CurrentSince Sep 14, 2020 Accepting new patients
Watertown Physician Practices LLC Current Accepting new patients
Pewaukee Vision SC Optometrist CurrentSince Oct 1, 2015 Accepting new patients
Wisconsin Vision, LLC Optometrist Past Accepting new patients
Wisconsin Vision, LLC Optometrist Past Accepting new patients
Wisconsin Vision, LLC Optometrist Past Accepting new patients
SE Professionals, S.C. Optometrist Past Accepting new patients
Wisconsin Vision, LLC Optometrist Past Accepting new patients

Locations

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

5102 S Packard Ave
Cudahy, WI 53110
Phone (414) 769-6120

120 Martin Dr
Fredonia, WI 53021
Phone (262) 692-9000

2305 30th Ave
Kenosha, WI 53144
Phone (262) 597-2020

10800 N Port Washington Rd
Mequon, WI 53092
Phone (262) 241-4848

8693 N Port Washington Rd
Milwaukee, WI 53217
Phone (414) 351-2020

2315 Silvernail Rd
Pewaukee, WI 53072
Phone (262) 521-9383

123 Hospital Dr
Ste 1002
Watertown, WI 53098
Phone (920) 261-8225

1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111

Organizations & group practices 11

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

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1609883990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10938 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925031",
            "telephone_number": "262-241-4848",
            "fax_number": "262-241-9865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5102 S Packard Ave",
            "address_purpose": "LOCATION",
            "city": "Cudahy",
            "state": "WI",
            "postal_code": "531101922",
            "country_code": "US",
            "telephone_number": "414-769-6120",
            "fax_number": "414-769-6998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAEFS",
        "first_name": "RENEE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.