Individual provider Active NPI

Paul R Dalecky, O.D.

  • Optometrist
  • Milwaukee, WI
National Provider Identifier
1790741809
Registry record updated Jan 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1709 Issued in WI
Practice address
1920 W Layton Ave
Milwaukee, WI 53221-5310
Phone
(414) 325-8600
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1709 WI Primary

Addresses

Primary practice location

1920 W Layton Ave
Milwaukee, WI 53221-5310

Mailing address

16800 W Cleveland Ave
New Berlin, WI 53151-3533
Phone (262) 432-2005

Other identifiers 1

IdentifierTypeStateIssuer
WI 1709OtherEYEMED VISION NO.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060427000116 WI Practitioner - Optometry 9537190012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wisconsin Vision, LLCGroup PAC ID 5698676518, 27 clinicians

Practice addresses (Care Compare)

5530 N Port Washington Rd
Unit C
Glendale, WI 53217-4920
Phone (414) 897-0152

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wisconsin Vision, LLC Optometrist CurrentSince Feb 3, 2010 Accepting new patients
Wisconsin Vision, LLC Optometrist CurrentSince Feb 3, 2010 Accepting new patients

Locations

351 N Casaloma Dr
Appleton, WI 54913
Phone (920) 749-1101

8225 S 27th St
Franklin, WI 53132
Phone (414) 761-2269

5530 N Port Washington Rd
Unit C
Glendale, WI 53217
Phone (414) 897-0152

2929 Milton Ave
Ste 140
Janesville, WI 53545
Phone (608) 756-0728

5725 75th St
Kenosha, WI 53142
Phone (262) 694-5553

5505 Odana Rd
Madison, WI 53719
Phone (608) 277-9393

1920 W Layton Ave
Milwaukee, WI 53221
Phone (414) 325-8600

16800 W Cleveland Ave
New Berlin, WI 53151
Phone (262) 432-2005

3905 Douglas Ave
Racine, WI 53402
Phone (262) 639-5360

2229 S Memorial Pl
Sheboygan, WI 53081
Phone (920) 458-9301

116 E Sunset Dr
Ste 100
Waukesha, WI 53189
Phone (262) 524-1130

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1790741809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16800 W CLEVELAND AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531513533",
            "telephone_number": "262-432-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 W LAYTON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215310",
            "telephone_number": "414-325-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALECKY",
        "first_name": "PAUL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED VISION NO.",
            "identifier": "WI 1709",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.