Mary Ellen Teclaw, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3440-35 Issued in WI

Practice address

17495 W Capitol Dr
Suite D
Brookfield, WI 53045-2059

Phone

(262) 797-9638

NPI assigned

Nov 21, 2016

Last updated

Aug 6, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olson Eye Care LLCGroup PAC ID 5294818589, 5 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Olson Eye Care LLC

  • Optometrist
  • Waupun, WI
  • NPI 1215119789
  Medicare reassignment Care Compare group NPD
• Phillip E Roy, O.D.

  • Optometrist
  • Brookfield, WI
  • NPI 1750406781
  Medicare reassignment
• Olson Eye Care LLC

  • Optometrist
  • Waupu, WI
  • NPI 1699904680
  NPD

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533513600000",
    "number": "1750824959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 COMMERCE DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537194941",
            "telephone_number": "608-833-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17495 W CAPITOL DR",
            "address_2": "SUITE D",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530452059",
            "telephone_number": "262-797-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TECLAW",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-21",
        "last_updated": "2018-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3440-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Nicole Tarmann
• Amanda Tatreau, APNP, FNP-BC
• Arriann Tauer, LPC
• Ashley Marlena Taylor, APNP
• Jennifer Taylor, DPT
• Seifu Teklemariam, RPH
• Dorota Halina Telega, M.D.
• Barbara Ann Temple, LPC
• Kelsey Tenaglia-Helm, PT
• Kyle Alan Tenboer, DPT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2018; 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.