Eyeglass Shopp LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

EYEGLASS SHOPP LLC

Practice address

200 Main St W
Ashland, WI 54806-1606

Phone

(715) 682-8181

Fax

(715) 682-8181

NPI assigned

Apr 23, 2019

Last updated

Apr 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Joseph Bailen, ABOCNPI 1326518002

Title

Member/Optician

Phone

(715) 682-8181

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Bailen, ABO

  • Optician
  • Ashland, WI
  • NPI 1326518002
  Authorized official Same address or phone

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1750945028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MAIN ST W",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548061606",
            "telephone_number": "715-682-8181",
            "fax_number": "715-682-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MAIN ST W",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548061606",
            "telephone_number": "715-682-8181",
            "fax_number": "715-682-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEGLASS SHOPP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "BAILEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "MEMBER/OPTICIAN",
        "authorized_official_telephone_number": "715-682-8181",
        "authorized_official_credential": "ABOC"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100085010",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Ashland, WI
• Providers in Ashland, WI by specialty
• Eyewear Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.