NPIMap

Organization Active NPI

Optical Dept. of Eye Clinic of Racine, LTD.

  • Eyewear Supplier
  • Racine, WI
National Provider Identifier
1629049150
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
OPTICAL DEPT. OF EYE CLINIC OF RACINE, LTD.
Practice address
3805A Spring St
Suite 111
Racine, WI 53405-1600
Phone
(262) 637-9615
Fax
(262) 637-4437
NPI assigned
Feb 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Joyce L Sawasky
Title
Business Manager
Phone
(262) 637-9615

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

3805A Spring St
Suite 111
Racine, WI 53405-1600

Mailing address

PO Box 1677
Racine, WI 53401-1677
Phone (262) 637-9615

Other identifiers 1

IdentifierTypeStateIssuer
38436400MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629049150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1677",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534011677",
            "telephone_number": "262-637-9615",
            "fax_number": "262-637-4437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805A SPRING ST",
            "address_2": "SUITE 111",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534051600",
            "telephone_number": "262-637-9615",
            "fax_number": "262-637-4437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL DEPT. OF EYE CLINIC OF RACINE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SAWASKY",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "262-637-9615",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38436400",
            "state": "WI"
        }
    ],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.