NPIMap

Organization Active NPI

The Eye Group SC

  • Optometrist
  • Waukesha, WI
National Provider Identifier
1659332823
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2760-035 Issued in WI
Legal business name
THE EYE GROUP SC
Practice address
3228 Turnberry Oak Dr
Suite 200
Waukesha, WI 53188-3969
Phone
(262) 542-7113
Fax
(262) 542-9439
NPI assigned
Mar 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Mr. Mark Dagenais, ODNPI 1316948516
Title
Owner/Optometrist
Phone
(262) 542-7113

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2760-035 WI Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 2704-035 WI

Addresses

Primary practice location

3228 Turnberry Oak Dr
Suite 200
Waukesha, WI 53188-3969

Mailing address

3228 Turnberry Oak Dr
Suite 200
Waukesha, WI 53188-3969
Phone (262) 542-7113

Other practice location 1

3670 S 108th St Ste 201
Greenfield, WI 53228-1210
Phone (414) 453-1010

Other identifiers 1

IdentifierTypeStateIssuer
DE9562OtherWIPALMETTO GBA-RAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040813001242 WI Part B Supplier - Clinic/Group Practice 3072586478 Receives reassigned benefits from 5 practitioners
Practice locations: Greenfield, WI; Waukesha, WI

National Provider Directory

National Provider Directory

Locations

3670 S 108th St
Ste 201
Greenfield, WI 53228
Phone (414) 453-1010

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

217 Wisconsin Ave
Ste 224
Waukesha, WI 53186
Phone (262) 542-7113

Practitioners & affiliated clinicians

Practitioners 5

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": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1659332823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3228 TURNBERRY OAK DR",
            "address_2": "SUITE 200",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883969",
            "telephone_number": "262-542-7113",
            "fax_number": "262-542-9439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3228 TURNBERRY OAK DR",
            "address_2": "SUITE 200",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883969",
            "telephone_number": "262-542-7113",
            "fax_number": "262-542-9439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3670 S 108th St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Greenfield",
            "state": "WI",
            "postal_code": "532281210",
            "country_code": "US",
            "telephone_number": "414-453-1010",
            "fax_number": "414-425-4230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE EYE GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "DAGENAIS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "262-542-7113",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2760-035",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2704-035",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA-RAILROAD MEDICARE",
            "identifier": "DE9562",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.