Individual provider Active NPI

Sandra Marie Landwehr, OD

  • Optometrist
  • Green Bay, WI
National Provider Identifier
1770544603
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2188 Issued in WI
Practice address
PO Box 12645
Green Bay, WI 54307-2645
Phone
(920) 494-2121
Fax
(920) 221-0117
NPI assigned
Mar 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2188 WI Primary

Addresses

Primary practice location

PO Box 12645
Green Bay, WI 54307-2645

Mailing address

PO Box 12645
Green Bay, WI 54307-2645
Phone (920) 494-2121

Other practice location 1

1700 W Stout St
Rice Lake, WI 54868-5000
Phone (715) 236-4450

Other identifiers 2

IdentifierTypeStateIssuer
38531700MedicaidWI
1770544603MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com

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
I20081029000523 WI Practitioner - Optometry 8426116898 Reassigns benefits to 10 organizations
Practice locations: Appleton, WI

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2188WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Aug 26, 2024 Accepting new patients
Menominee Indian Tribe of Wisconsin CurrentSince Feb 1, 2023 Accepting new patients
MCHS Hospitals Inc CurrentSince Aug 26, 2024 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Aug 26, 2024 Accepting new patients
Memorial Hospital Inc CurrentSince Aug 26, 2024 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Aug 26, 2024 Accepting new patients
Marshfield Clinic Inc CurrentSince Aug 26, 2024 Accepting new patients
MCHS Hospitals Inc CurrentSince Aug 26, 2024 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Aug 26, 2024 Accepting new patients
MCHS Hospitals Inc Current Accepting new patients
MCHS Hospitals Inc Current Accepting new patients
Flambeau Hospital Inc CurrentSince Aug 26, 2024 Accepting new patients
Flambeau Hospital Inc Current Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

705 S University Ave
Ofc
Beaver Dam, WI 53916

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1102 S Center Ave
Merrill, WI 54452
Phone (715) 536-3399

N3708 River Ave
Neillsville, WI 54456
Phone (715) 743-3101

1700 W Stout St
Rice Lake, WI 54868
Phone (715) 236-6133

Interoperability endpoints

  • Direct secure messaging: him@marshfieldclinichealthsystem.cernerdirect.com

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1770544603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12645",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543072645",
            "telephone_number": "920-494-2121",
            "fax_number": "920-221-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 12645",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543072645",
            "telephone_number": "920-494-2121",
            "fax_number": "920-221-0117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 W Stout St",
            "address_purpose": "LOCATION",
            "city": "Rice Lake",
            "state": "WI",
            "postal_code": "548685000",
            "country_code": "US",
            "telephone_number": "715-236-4450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDWEHR",
        "first_name": "SANDRA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-30",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38531700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770544603",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1700 W Stout St",
            "city": "Rice Lake",
            "state": "WI",
            "country_code": "US",
            "postal_code": "548685000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.