Active NPI
Michael J Wind, O.D.
- Optometrist
- Manitowoc, WI
National Provider Identifier
1679567929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1608
- Practice address
- 4801 Expo Dr
Manitowoc, WI 54220-9341 - Phone
- (920) 684-4429
- Fax
- (920) 684-6892
- NPI assigned
- Sep 1, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1608 | WI | Primary |
Addresses
Primary practice location
4801 Expo Dr
Manitowoc, WI 54220-9341
Mailing address
PO Box 1900
Manitowoc, WI 54221-1900
Phone (920) 684-4429
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38500200 | Medicaid | WI | |
| 39748359005 | Other | WI | BLUE CROSS/BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Clinic of Manitowoc, S.C. | Optometrist | Current | Accepting new patients |
| Two Rivers Eye Clinic | Optometrist | Past | Accepting new patients |
Locations
4801 Expo Dr
Manitowoc, WI 54220
Phone (920) 684-4429
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267056000000",
"number": "1679567929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1900",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542211900",
"telephone_number": "920-684-4429",
"fax_number": "920-684-6892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 EXPO DR",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542209341",
"telephone_number": "920-684-4429",
"fax_number": "920-684-6892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIND",
"first_name": "MICHAEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-01",
"last_updated": "2010-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1608",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38500200",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "39748359005",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.