Active NPI
Amy Ellen Boettcher
- Optician
- Chippewa Falls, WI
National Provider Identifier
1790959815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- Practice address
- 2525 County Highway I
Chippewa Falls, WI 54729-1422 - Phone
- (715) 723-6520
- Fax
- (715) 723-1092
- NPI assigned
- Apr 18, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | Primary |
Addresses
Primary practice location
2525 County Highway I
Chippewa Falls, WI 54729-1422
Mailing address
2525 County Highway I
Chippewa Falls, WI 54729-1422
Phone (715) 723-6520
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38459500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208476800000",
"number": "1790959815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 COUNTY HIGHWAY I",
"city": "CHIPPEWA FALLS",
"state": "WI",
"postal_code": "547291422",
"telephone_number": "715-723-6520",
"fax_number": "715-723-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 COUNTY HIGHWAY I",
"city": "CHIPPEWA FALLS",
"state": "WI",
"postal_code": "547291422",
"telephone_number": "715-723-6520",
"fax_number": "715-723-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOETTCHER",
"first_name": "AMY",
"middle_name": "ELLEN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-18",
"last_updated": "2008-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38459500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chippewa Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.