Individual provider Active NPI

Lauren Mae Leurquin, OD

  • Optometrist
  • Wausau, WI
National Provider Identifier
1770143984
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3567-35 Issued in WI
Practice address
205 W Bridge St
Wausau, WI 54401-3000
Phone
(715) 848-2020
NPI assigned
Jun 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3567-35 WI Primary

Addresses

Primary practice location

205 W Bridge St
Wausau, WI 54401-3000

Mailing address

824 N 3Rd Ave
Wausau, WI 54401-2819
Phone (715) 432-5877

Other practice location 1

400 Dewey St
Wisconsin Rapids, WI 54494-4715
Phone (715) 424-4141

Other practice location 2

174 Crossroads Dr
Plover, WI 54467-4122
Phone (715) 342-9634

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190717002297 WI Practitioner - Optometry 8224363973 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyecare Center of Wausau LLCGroup PAC ID 5890993117, 3 clinicians

Practice addresses (Care Compare)

611 Stevens Dr
Wausau, WI 54401-3006
Phone (715) 848-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3567-35WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecare Center of Wausau LLC Optometrist CurrentSince Dec 20, 2022 Accepting new patients
Eye Wear Designs of Marshfield LLC Optometrist Past Accepting new patients
Nikolay Chiropractic LLC PastSince Sep 24, 2023 Accepting new patients

Locations

205 W Bridge St
Ste 101
Wausau, WI 54401
Phone (715) 848-2020

611 Stevens Dr
Wausau, WI 54401
Phone (715) 848-2020

205 W Bridge St
Wausau, WI 54401
Phone (715) 848-2020

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1770143984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 N 3RD AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012819",
            "telephone_number": "715-432-5877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W BRIDGE ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013000",
            "telephone_number": "715-848-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Dewey St",
            "address_purpose": "LOCATION",
            "city": "Wisconsin Rapids",
            "state": "WI",
            "postal_code": "544944715",
            "country_code": "US",
            "telephone_number": "715-424-4141",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "174 Crossroads Dr",
            "address_purpose": "LOCATION",
            "city": "Plover",
            "state": "WI",
            "postal_code": "544674122",
            "country_code": "US",
            "telephone_number": "715-342-9634",
            "fax_number": "715-342-9244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEURQUIN",
        "first_name": "LAUREN",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-19",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3567-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.