Autumn Kay Wicke, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004333 Issued in MI

Practice address

1555 Brady Road
Chesaning, MI 48616-0355

Phone

(989) 845-7050

Fax

(989) 845-2036

NPI assigned

Mar 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Michigan Professional LLCGroup PAC ID 7113395864, 23 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Aeg Michigan Professional LLC

  • Optometrist
  • Chesaning, MI
  • NPI 1053032912
  Medicare reassignment Care Compare group NPD
• David E. Duryea, O.D., P.C.

  dba Advanced Eyecare & Contact Lens Center

  • Optometrist
  • Chesaning, MI
  • NPI 1285603092
  Medicare reassignment NPD
• David E. Duryea, O.D., P.C

  dba Advanced Eyecare & Contact Lens Center

  • Optometrist
  • Chesaning, MI
  • NPI 1285847509
  NPD (past)
• Suburban Optometrics Assoc P C

  • Optometrist
  • Livonia, MI
  • NPI 1952518748
  NPD (past)

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246492800000",
    "number": "1770552671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 BRADY ROAD",
            "city": "CHESANING",
            "state": "MI",
            "postal_code": "486160355",
            "telephone_number": "989-845-7050",
            "fax_number": "989-845-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 BRADY ROAD",
            "city": "CHESANING",
            "state": "MI",
            "postal_code": "486160355",
            "telephone_number": "989-845-7050",
            "fax_number": "989-845-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKE",
        "first_name": "AUTUMN",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-15",
        "last_updated": "2009-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "944824022",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Vrable
• Sarah Walter
• Christina Warby
• Alana Wendling
• Alexia Wendling
• Mary Zayac
• Madison Zimmerman

• Optometrist in Chesaning, MI
• Providers in Chesaning, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; 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.