NPIMap

Organization Active NPI

Optical Fashions LTD

  • Optometrist
  • Holmen, WI
National Provider Identifier
1780198515
Registry record updated Dec 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2705 Issued in WI
Legal business name
OPTICAL FASHIONS LTD
Practice address
814 S Main St Ste a
Holmen, WI 54636-9632
Phone
(608) 782-7127
Fax
(608) 399-3097
NPI assigned
Dec 1, 2017
Organization subpart
Yes
Parent organization
OPTICAL FASHIONS LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2017

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

Authorized official

Name
Suzanne M Ekhoff
Title
Insurance Manager
Phone
(608) 782-7127

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2705 WI Primary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3116 WI
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3129 WI
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3359 WI

Addresses

Primary practice location

814 S Main St Ste a
Holmen, WI 54636-9632

Mailing address

2104 State Road 16
La Crosse, WI 54601-3046
Phone (608) 782-7127

Other identifiers 5

IdentifierTypeStateIssuer
38709300MedicaidWI
100020764MedicaidWI
38602800MedicaidWI
38645900MedicaidWI
100039841MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050110000483 WI Part B Supplier - Clinic/Group Practice 0840248522 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Crosse, WI; Holmen, WI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Optical Fashions LTD

Locations

2104 Wi 16
La Crosse, WI 54601
Phone (608) 782-7127

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1512086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512086400000",
    "number": "1780198515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 STATE ROAD 16",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546013046",
            "telephone_number": "608-782-7127",
            "fax_number": "608-782-7124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 S MAIN ST STE A",
            "city": "HOLMEN",
            "state": "WI",
            "postal_code": "546369632",
            "telephone_number": "608-782-7127",
            "fax_number": "608-399-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICAL FASHIONS LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTICAL FASHIONS LTD",
        "enumeration_date": "2017-12-01",
        "last_updated": "2017-12-01",
        "status": "A",
        "authorized_official_last_name": "EKHOFF",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "608-782-7127"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2705",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3116",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3129",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3359",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38709300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100020764",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38602800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38645900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100039841",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holmen, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; 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.