NPIMap

Organization Active NPI

North Shore Eye Health and Wellness, SC

Doing business as North Shore Eye Health and Wellness

  • Optometrist
  • Cedarburg, WI
National Provider Identifier
1629494703
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3226-035 Issued in WI
Legal business name
NORTH SHORE EYE HEALTH AND WELLNESS, SC
Doing business as
North Shore Eye Health and Wellness
Practice address
N54W6135 Mill St
Suite 700
Cedarburg, WI 53012-2021
Phone
(262) 421-4412
Fax
(262) 421-4413
NPI assigned
Mar 12, 2014
Last updated
Sep 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Authorized official

Name
Dr. Kyle David Ross, OD, FAAONPI 1972881134
Title
President
Phone
(262) 421-4412

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3226-035 WI Primary

Addresses

Primary practice location

N54W6135 Mill St
Suite 700
Cedarburg, WI 53012-2021

Mailing address

N54W6135 Mill St
Suite 700
Cedarburg, WI 53012-2021
Phone (262) 421-4412

Other names 1

  • North Shore Eye Health and Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140423001698 WI Part B Supplier - Clinic/Group Practice 1951534163 Receives reassigned benefits from 2 practitioners
Practice locations: Cedarburg, WI

National Provider Directory

National Provider Directory

Locations

N54W6135 Mill St
Ste 700
Cedarburg, WI 53012
Phone (262) 421-4412

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1629494703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N54W6135 MILL ST",
            "address_2": "SUITE 700",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122021",
            "telephone_number": "262-421-4412",
            "fax_number": "262-421-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N54W6135 MILL ST",
            "address_2": "SUITE 700",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122021",
            "telephone_number": "262-421-4412",
            "fax_number": "262-421-4413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE EYE HEALTH AND WELLNESS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-12",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-421-4412",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD, FAAO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3226-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Eye Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedarburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.