Summit Eye Clinic SC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1780 Issued in WI

Legal business name

SUMMIT EYE CLINIC SC

Practice address

608 East Summit Ave
Oconomowoc, WI 53066-3841

Phone

(262) 567-6565

Fax

(262) 567-8214

NPI assigned

May 31, 2006

Organization subpart

No

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

Authorized official

Name

Randy J Prestash, OD

Title

President

Phone

(262) 567-6565

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 3

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

• Dana S McGuire, OD

  • Optometrist
  • Oconomowoc, WI
  • NPI 1023038189
  Medicare reassignment NPD
• John David Bonsett-Veal, O.D.

  • Optometrist
  • Madison, WI
  • NPI 1578587978
  NPD (past)
• Mark S Spankowski, OD

  • Optometrist
  • Oconomowoc, WI
  • NPI 1831223338
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299801600000",
    "number": "1679520845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 E SUMMIT AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "53066",
            "telephone_number": "262-567-6565",
            "fax_number": "262-567-8214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 EAST SUMMIT AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663841",
            "telephone_number": "262-567-6565",
            "fax_number": "262-567-8214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT EYE CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2011-03-11",
        "status": "A",
        "authorized_official_last_name": "PRESTASH",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-567-6565",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38711000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Struck, LPC
• Skyler Stubblefield, PHARMD
• Danielle Stuckert
• Kent W Stultz, RPH
• Summit Dental Excellence
• Jennifer L Swanson, EDD
• Paula Swartz, LCSW
• Sandy L Swords, CADCIII
• Kristen L. Szajna, RN
• Karla L Szewczykowski, RDH BSDH

• Optometrist in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; 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.