Individual provider Active NPI

Bryce Boente, OD

  • Optometrist
  • Waukesha, WI
National Provider Identifier
1619604972
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3804-35 Issued in WI
Practice address
1166 W Sunset Dr
Waukesha, WI 53189-8441
Phone
(262) 574-9410
NPI assigned
Aug 5, 2022
Last updated
Aug 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3804-35 WI Primary

Addresses

Primary practice location

1166 W Sunset Dr
Waukesha, WI 53189-8441

Mailing address

1632 N Franklin PL Apt 411
Milwaukee, WI 53202-3771
Phone (217) 710-2933

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
I20220909001202 WI Practitioner - Optometry 1850774134 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

1210 12TH Ave
Grafton, WI 53024-1924
Phone (262) 377-6800

6000 Monona Dr
Suite 101
Monona, WI 53716-3329
Phone (608) 222-9420

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Shoptikal LLC Optometrist CurrentSince Aug 22, 2022 Accepting new patients
Peak Eye Care, SC Optometrist CurrentSince Dec 5, 2024 Accepting new patients
Shoptikal LLC Optometrist Current Accepting new patients
Shoptikal LLC Optometrist CurrentSince Aug 22, 2022 Accepting new patients
Shoptikal LLC Optometrist Past Accepting new patients
Shoptikal LLC Optometrist PastSince Aug 7, 2022 Accepting new patients
Shoptikal LLC Optometrist Past Accepting new patients

Locations

1210 12th Ave
Grafton, WI 53024
Phone (262) 377-6800

1595 E Sumner St
Ste 108
Hartford, WI 53027
Phone (262) 709-8211

3670 S 108th St
Ste 204
Milwaukee, WI 53228
Phone (414) 425-4141

6000 Monona Dr
Ste 101
Monona, WI 53716
Phone (608) 222-9420

1745 S Main St
Unit 7
West Bend, WI 53095
Phone (262) 334-7077

Organizations & group practices 7

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": "1659657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1619604972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1632 N FRANKLIN PL APT 411",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532023771",
            "telephone_number": "217-710-2933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1166 W SUNSET DR",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531898441",
            "telephone_number": "262-574-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOENTE",
        "first_name": "BRYCE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-05",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3804-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.