NPIMap

Organization Active NPI

Wegner Vision Clinic, SC

  • Optometrist
  • Racine, WI
National Provider Identifier
1619090073
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2647 Issued in WI
Legal business name
WEGNER VISION CLINIC, SC
Practice address
1120 Grove Ave
Racine, WI 53405-3028
Phone
(262) 637-7917
Fax
(262) 637-6786
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

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

Authorized official

Name
Dr. Jon R Wegner, O.D.
Title
Optometrist
Phone
(262) 637-7917

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2647 WI Primary

Addresses

Primary practice location

1120 Grove Ave
Racine, WI 53405-3028

Mailing address

1120 Grove Ave
Racine, WI 53405-3028
Phone (262) 637-7917

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120411000546 WI Part B Supplier - Clinic/Group Practice 7012119910 Practice locations: Racine, WI

National Provider Directory

National Provider Directory

Locations

1120 Grove Ave
Racine, WI 53405
Phone (262) 637-7917

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333497600000",
    "number": "1619090073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 GROVE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534053028",
            "telephone_number": "262-637-7917",
            "fax_number": "262-637-6786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 GROVE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534053028",
            "telephone_number": "262-637-7917",
            "fax_number": "262-637-6786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEGNER VISION CLINIC, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2012-04-04",
        "status": "A",
        "authorized_official_last_name": "WEGNER",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "262-637-7917",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.