Eyecare Center of Wausau LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2687 Issued in WI

Legal business name

EYECARE CENTER OF WAUSAU LLC

Practice address

611 Stevens Dr
Wausau, WI 54401-3006

Phone

(715) 848-2020

Fax

(715) 845-6669

NPI assigned

Feb 11, 2009

Organization subpart

No

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

Authorized official

Name

Gregory Lee Leischer, ODNPI 1285770065

Title

Owner

Phone

(715) 848-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eyecare Center of Wausau Other name

Medicare fee-for-service enrollment

Enrolled in WI3 enrollments

Enrollment records 3

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Gregory Lee Leischer, O.D.

  • Optometrist
  • Wausau, WI
  • NPI 1285770065

  O20100930100659

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory Lee Leischer, O.D.

  • Optometrist
  • Wausau, WI
  • NPI 1285770065
  Medicare reassignment Care Compare group NPD Authorized official
• Kelsey B Koerner, O.D.

  • Optometrist
  • Wausau, WI
  • NPI 1659729580
  Medicare reassignment Care Compare group NPD
• Lauren Mae Leurquin, OD

  • Optometrist
  • Wausau, WI
  • NPI 1770143984
  Medicare reassignment Care Compare group NPD
• Robert John Alexejun, O.D.

  • Optometrist
  • Wausau, WI
  • NPI 1235275009
  NPD (past)
• Brian Damien Puent, MS OD

  • Optometrist
  • Wausau, WI
  • NPI 1578530648
  NPD (past)

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1770722993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 STEVENS DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013006",
            "telephone_number": "715-848-2020",
            "fax_number": "715-845-6669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 STEVENS DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013006",
            "telephone_number": "715-848-2020",
            "fax_number": "715-845-6669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "611 Stevens Drive",
            "address_purpose": "LOCATION",
            "city": "Wausau",
            "state": "WI",
            "postal_code": "544013000",
            "country_code": "US",
            "telephone_number": "715-848-2020",
            "fax_number": "715-845-6669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EYECARE CENTER OF WAUSAU LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "LEISCHER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-848-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "000047394",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eyecare Center of Wausau",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Eyecare Center of Wausau",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Stephanie L Eversdyk, CMA
• Evolve Counseling LLC
• Evolve Pelvic Wellness LLC
• Elissa Susan Ewan, DPT
• Eye Clinic of Wisconsin SC
• Eyemart Express LLC
• F and J Inc
• Joan Faber
• Kelly Fabry, P.T.A.
• Ralph B Fairchild III, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.