Thielke Family Eye Care, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3145-035 Issued in WI

Legal business name

THIELKE FAMILY EYE CARE, LLC

Practice address

2212 Glacier Dr
Saint Croix Falls, WI 54024-8347

Phone

(715) 483-2571

NPI assigned

Jan 5, 2015

Organization subpart

No

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

Authorized official

Name

Trent N. Thielke, O.D.

Title

Registered Agent

Phone

(715) 808-0480

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1790173425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 WERT RD",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2212 GLACIER DR",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540248347",
            "telephone_number": "715-483-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIELKE FAMILY EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "THIELKE",
        "authorized_official_first_name": "TRENT",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "715-808-0480",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3145-035",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3183",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Saint Croix Falls, WI
• Providers in Saint Croix Falls, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.