NPIMap

Organization Active NPI

St Croix Falls Eye Associates Inc.

Doing business as Frederic Eye Associates

  • Optometrist
  • Frederic, WI
National Provider Identifier
1669585352
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
ST CROIX FALLS EYE ASSOCIATES INC.
Doing business as
Frederic Eye Associates
Practice address
108 Oak St
Frederic, WI 54837-9547
Phone
(715) 327-8239
Fax
(608) 571-0088
NPI assigned
Aug 16, 2006
Last updated
Jun 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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

Authorized official

Name
Mr. Lawrence S Tran, O.D.NPI 1730143967
Title
Owner/Optometrist
Phone
(715) 483-3259

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
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

108 Oak St
Frederic, WI 54837-9547

Mailing address

PO Box 767
Saint Croix Falls, WI 54024-0767
Phone (715) 483-3259

Other names 1

  • Frederic Eye Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816001181 WI Part B Supplier - Clinic/Group Practice 0244203412 Receives reassigned benefits from 3 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Croix Falls, WI; Webster, WI; Grantsburg, WI; Frederic, WI

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Jacobson Advanced Eye Care Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

215 Main St
Ste 101
Balsam Lake, WI 54810
Phone (715) 483-3259

617 S Pine St
Grantsburg, WI 54840
Phone (715) 463-2370

Practitioners & affiliated clinicians

Practitioners 8

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": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1669585352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540240767",
            "telephone_number": "715-483-3259",
            "fax_number": "608-571-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 OAK ST",
            "city": "FREDERIC",
            "state": "WI",
            "postal_code": "548379547",
            "telephone_number": "715-327-8239",
            "fax_number": "608-571-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX FALLS EYE ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "715-483-3259",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Frederic Eye Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frederic, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.