Jacob B Vergin, O.D.
Individual provider Active NPI Optometrist · Chippewa Falls, WI
NPI 1710185442 · NPPES record last updated Jun 23, 2008
Key facts
- NPI
- 1710185442
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3083-035 (WI)
- Practice address
- 331 E Prairie View Rd
Chippewa Falls, WI 54729-3463 - Phone
- (715) 726-9077
- NPI assigned
- Jul 3, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cardinal Family Eye Care LLC
Practice addresses (Care Compare)
509 E S Ave
Chippewa Falls, WI 54729-3402
Phone (715) 726-9077
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 13 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071203000425 | WI | Practitioner - Optometry | 4284723933 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3083-035 | WI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cardinal Family Eye Care LLC | Optometrist | Current |
Accepting new patients |
Locations
509 E South Ave
Chippewa Fls, WI 54729
Phone (715) 726-9077
201 E Hill St
Thorp, WI 54771
Phone (715) 669-5631
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3083-035 | WI | Yes |
Addresses
Primary practice location
331 E Prairie View Rd
Chippewa Falls, WI 54729-3463
Mailing address
13151 39TH Ave N
Chippewa Falls, WI 54729-7144
Phone (773) 297-5096
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38642900 | Medicaid | WI |
Other providers in Chippewa Falls, WI
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- Kent Vandehaar
- Gao Zoo Vang
- Maureen G Vanyo
- Rupal Suresh Vasani
- Lindsay Vogel
- Wal-Mart Stores East , LP
- Wal-Mart Stores East., LP
- Lucretia Coann Waldbuesser
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All providers in Chippewa Falls, WI · Optometrist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.