Lisa La Susa, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3336-35 Issued in WI

Practice address

1437 S Main St
West Bend, WI 53095-4931

Phone

(262) 334-1925

NPI assigned

Jun 11, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Optometry

Education

International American University at Puerto Rico - School of Optometry, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wagnertc P CGroup PAC ID 7719226489, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wagnertc P C

  • Optometrist
  • The Woodlands, TX
  • NPI 1750576435
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1730593310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1437 S MAIN ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530954931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1437 S MAIN ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530954931",
            "telephone_number": "262-334-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA SUSA",
        "first_name": "LISA",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3336-35",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8496T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacki Kunze
• Valerie Kurtz
• Brandon Kusik, DMD
• Jesse Kutz, PHARMD
• Joan Marie Kutz, RN
• John P Lacey Jr.
• Christina M Lachner, M.S., LPC-IT
• Ladybugs Home Care Services LLC
• Carrie Lake, HIS
• Lakeshore Community Health Care, Inc

• Optometrist in West Bend, WI
• Providers in West Bend, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.