Individual provider Active NPI

Nicole Renee Jonas, OD

  • Optometrist
  • Brookfield, WI
National Provider Identifier
1710085709
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3014 Issued in WI
Practice address
200 S Executive Dr
Suite 101
Brookfield, WI 53005-4216
Phone
(888) 964-6681
Fax
(888) 662-0859
NPI assigned
Sep 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3014 WI Primary

Addresses

Primary practice location

200 S Executive Dr
Suite 101
Brookfield, WI 53005-4216

Mailing address

888 Worcester St
Suite 130
Wellesley, MA 02482-3744
Phone (617) 964-6681

Other identifiers 2

IdentifierTypeStateIssuer
38626600MedicaidWI
P00224977OtherWIRAILROAD MEDICARE

Other names 1

  • Nicole Renee Miesner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050714000563 WI Practitioner - Optometry 3577599125 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jeffrey L Morer OD PCGroup PAC ID 7719870807, 50 clinicians

Practice addresses (Care Compare)

1320 Wisconsin Ave
Racine, WI 53403-1978
Phone (262) 687-2241

13755 W Fieldpoint Dr
New Berlin, WI 53151-3979
Phone (262) 796-3600

9047 W Greenfield Ave
West Allis, WI 53214-2808
Phone (414) 453-9290

S77 W18690 Janesville Rd
Muskego, WI 53150-9207
Phone (262) 679-0246

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3014WIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey L. Morer, OD, PC Optometrist CurrentSince Jul 11, 2005 Accepting new patients
Jeffrey L. Morer, OD, PC Optometrist CurrentSince Jul 11, 2005 Accepting new patients

Locations

100 Crossing Blvd
Ste 300
Framingham, MA 01702
Phone (857) 255-0486

888 Worcester St
Ste 130
Wellesley, MA 02482
Phone (857) 255-0293

200 S Executive Dr
Ste 101
Brookfield, WI 53005
Phone (262) 262-6707

9047 W Greenfield Ave
West Allis, WI 53214
Phone (414) 453-9290

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": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1710085709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 WORCESTER ST",
            "address_2": "SUITE 130",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024823744",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S EXECUTIVE DR",
            "address_2": "SUITE 101",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054216",
            "telephone_number": "888-964-6681",
            "fax_number": "888-662-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONAS",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38626600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00224977",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "MIESNER",
            "middle_name": "RENEE",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.