Kenosha Family Vision Care LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3309-35 Issued in WI

Legal business name

KENOSHA FAMILY VISION CARE LLC

Doing business as

Regner Family Vision Clinic

Practice address

4014 77TH St
Kenosha, WI 53142-4314

Phone

(262) 694-9103

Fax

(262) 694-9106

NPI assigned

Mar 26, 2014

Last updated

Mar 26, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tristan Robert Begotka, O.D.

Title

Owner

Phone

(262) 694-9103

Specialties & licenses 1

Addresses

Other names 1

• Regner Family Vision Clinic Doing business as

Practitioners 1

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.

• Jennifer L Ayers, OD

  • Optometrist
  • Kenosha, WI
  • NPI 1932285400
  NPD (past)

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1679990774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4014 77TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424314",
            "telephone_number": "262-694-9103",
            "fax_number": "262-694-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4014 77TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424314",
            "telephone_number": "262-694-9103",
            "fax_number": "262-694-9106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA FAMILY VISION CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-26",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "BEGOTKA",
        "authorized_official_first_name": "TRISTAN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-694-9103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3309-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regner Family Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.