Beloit Family Eye Care S.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3136-035 Issued in WI

Legal business name

BELOIT FAMILY EYE CARE S.C.

Practice address

540 E Grand Ave
Beloit, WI 53511-6314

Phone

(608) 365-8575

Fax

(608) 362-2655

NPI assigned

May 11, 2011

Organization subpart

No

Name

Dr. Douglas Edward Kelley, ODNPI 1033376090

Title

Manager

Phone

(608) 365-8575

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

• Douglas Edward Kelley, OD

  • Optometrist
  • Beloit, WI
  • NPI 1033376090
  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 17, 2011.

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313539200000",
    "number": "1780976647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 E GRAND AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116314",
            "telephone_number": "608-365-8575",
            "fax_number": "608-362-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E GRAND AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116314",
            "telephone_number": "608-365-8575",
            "fax_number": "608-362-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELOIT FAMILY EYE CARE S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2011-08-17",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "608-365-8575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3136-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Beloit, WI
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2011; 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.