Individual provider Active NPI

Corinne Beiersdorf Wicklund, OD

  • Optometrist
  • Plymouth, WI
National Provider Identifier
1649290941
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3046-035 Issued in WI
Practice address
100 Carr Rd
Plymouth, WI 53073-9500
Phone
(920) 892-3937
Fax
(920) 892-6668
NPI assigned
Jul 20, 2006
Last updated
Sep 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3046-035 WI Primary
Low Vision Rehabilitation Optometrist 152WL0500X 3046-035 WI

Addresses

Primary practice location

100 Carr Rd
Plymouth, WI 53073-9500

Mailing address

PO Box 600
Plymouth, WI 53073-0600
Phone (920) 893-3937

Other identifiers 1

IdentifierTypeStateIssuer
3046-035OtherWISTATE LICENSE NUMBER

Other names 1

  • Corinne Beiersdorf Former name

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
I20061030000222 WI Practitioner - Optometry 7012914385 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
20-20 Visions LLCGroup PAC ID 0749275782, 3 clinicians
Jeffrey L Morer OD PCGroup PAC ID 7719870807, 50 clinicians

Practice addresses (Care Compare)

100 Carr Rd
Plymouth, WI 53073-9500
Phone (920) 893-3937

200 S 9TH St
De Pere, WI 54115-1393
Phone (920) 336-5680

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3046-035WIMDLow Vision Rehabilitation Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey L. Morer, OD, PC Optometrist CurrentSince Sep 16, 2025 Accepting new patients
Jeffrey L. Morer, OD, PC Optometrist CurrentSince Sep 16, 2025 Accepting new patients
20-20 Visions LLC Optometrist CurrentSince Jul 7, 2022 Accepting new patients

Locations

100 Crossing Blvd
Ste 300
Framingham, MA 01702
Phone (857) 255-0486

200 S 9th St
De Pere, WI 54115
Phone (920) 336-5680

100 Carr Rd
Plymouth, WI 53073
Phone (920) 892-3937

9047 W Greenfield Ave
West Allis, WI 53214
Phone (414) 453-9290

Organizations & group practices 3

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1649290941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530730600",
            "telephone_number": "920-893-3937",
            "fax_number": "920-892-6668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CARR RD",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530739500",
            "telephone_number": "920-892-3937",
            "fax_number": "920-892-6668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLUND",
        "first_name": "CORINNE",
        "middle_name": "BEIERSDORF",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3046-035",
            "primary": true
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "WI",
            "license": "3046-035",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "3046-035",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORINNE",
            "last_name": "BEIERSDORF",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plymouth, WI

Sources for this page

Verify at the official NPI Registry.