Advanced Eyecare & Contact Lens Center, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2495 Issued in WI

Legal business name

ADVANCED EYECARE & CONTACT LENS CENTER, LLC

Practice address

154 E Geneva SQ
Lake Geneva, WI 53147-9694

Phone

(262) 249-1000

Fax

(262) 249-1255

NPI assigned

Jul 10, 2008

Last updated

Jul 15, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Inger Gibson, ODNPI 1386637007

Title

Owner

Phone

(262) 249-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Inger L Gibson, OD

  • Optometrist
  • Lake Geneva, WI
  • NPI 1386637007
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216080000000",
    "number": "1780848523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 E GENEVA SQ",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531479694",
            "telephone_number": "262-249-1000",
            "fax_number": "262-249-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 E GENEVA SQ",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531479694",
            "telephone_number": "262-249-1000",
            "fax_number": "262-249-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED EYECARE & CONTACT LENS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-15",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "INGER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-249-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38618100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annapurna Adiga, RPH
• Aya Akram Al-Anani
• Nestor C Alabarca, MD
• Zachary P Allegretti, MD
• Mialee Ambrose
• Judith Ellen Anderson Mayer, RN

• Optometrist in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; 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.