Alexander Eye Institute, SC
Organization Active NPI Ophthalmology Physician · Appleton, WI
NPI 1740317841 · NPPES record last updated May 4, 2010
Key facts
- NPI
- 1740317841
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 30180 (WI)
- Legal business name
- ALEXANDER EYE INSTITUTE, SC
- Practice address
- 250 N Metro Drive
Appleton, WI 54913-8571 - Phone
- (920) 830-2020
- Fax
- (920) 830-1118
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kimberly Kay Goddard, COT/ROOB
- Title
- Ophthalmic Technician
- Phone
- (920) 830-2020
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2020547 | Alexander Eye Institute, SC | Certificate of waiver | Feb 23, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100914000441 | WI | Part B Supplier - Clinic/Group Practice | 3577688621 |
Receives reassigned benefits from 1 practitioner Practice locations: Appleton, WI |
National Provider Directory
Locations
250 N Metro Dr
Appleton, WI 54913
Phone (920) 830-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician |
207W00000X | 30180 | WI | Yes |
Addresses
Primary practice location
250 N Metro Drive
Appleton, WI 54913-8571
Mailing address
250 N Metro Drive
Appleton, WI 54913-8571
Phone (920) 830-2020
Other names
- Alexander Eye Institute
Other providers in Appleton, WI
- Rana Sameer Alahmedi
- Maurizio Zeki Albala
- Jordyn Albrecht
- Gregory A. Aleff
- Kayla Aleson
- Alexander Eye Surgery Center, LLC
- Avery Delvin Alexander
- Heather Alford
- Syed Taimur Ali
- Alissa Edwards DDS LLC
All providers in Appleton, WI · Ophthalmology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2010. 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.
- 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.