NPIMap

Organization Active NPI

Pewaukee Vision SC

  • Optometrist
  • Waukesha, WI
National Provider Identifier
1780053595
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PEWAUKEE VISION SC
Practice address
1111 Delafield St Ste 212
Waukesha, WI 53188-3403
Phone
(262) 521-9383
Fax
(262) 547-1815
NPI assigned
Sep 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Authorized official

Name
Elyse BrunsNPI 1407204506
Title
Co-Owner
Phone
(715) 892-2691

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X Primary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X

Addresses

Primary practice location

1111 Delafield St Ste 212
Waukesha, WI 53188-3403

Mailing address

1111 Delafield St Ste 212
Waukesha, WI 53188-3403
Phone (262) 521-9383

Other practice location 1

2315 Silvernail Rd
Pewaukee, WI 53072-5402
Phone (262) 521-9383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160405001632 WI Part B Supplier - Clinic/Group Practice 5698072783 Receives reassigned benefits from 3 practitioners
Practice locations: Pewaukee, WI; Waukesha, WI

National Provider Directory

National Provider Directory

Locations

1111 Delafield St
Ste 212
Waukesha, WI 53188
Phone (262) 544-8622

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1780053595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST STE 212",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-521-9383",
            "fax_number": "262-547-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST STE 212",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883403",
            "telephone_number": "262-521-9383",
            "fax_number": "262-547-1815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2315 Silvernail Rd",
            "address_purpose": "LOCATION",
            "city": "Pewaukee",
            "state": "WI",
            "postal_code": "530725402",
            "country_code": "US",
            "telephone_number": "262-521-9383",
            "fax_number": "262-521-9484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEWAUKEE VISION SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-22",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "BRUNS",
        "authorized_official_first_name": "ELYSE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "715-892-2691"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.