Myeyedr Optometry of Wisconsin, LLC
Organization Active NPI Optometrist · Wisconsin Rapids, WI
NPI 1801460563 · NPPES record last updated May 18, 2021
Key facts
- NPI
- 1801460563
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- MYEYEDR OPTOMETRY OF WISCONSIN, LLC
- Practice address
- 1220 Parkwood Dr
Wisconsin Rapids, WI 54494-5488 - Phone
- (715) 421-2111
- Fax
- (715) 421-2123
- NPI assigned
- May 18, 2021
- Organization subpart
- No
Authorized official
- Name
- Sue Downes
- Title
- Secretary
- Phone
- (703) 847-8899
Other NPIs on the same Medicare enrollment 15
Practitioners 6
-
Cody W Dagnall, OD
-
Rozaliya Shimonova, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2085868 | Myeyedr Optometry of Wisconsin, LLC | Certificate of waiver | Oct 23, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190219000001 | WI | Part B Supplier - Clinic/Group Practice | 5890033716 |
Receives reassigned benefits from 100 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cudahy, WI; Wisconsin Rapids, WI; West Allis, WI; Wauwatosa, WI; Waukesha, WI; Sheboygan, WI; Racine, WI; New Berlin, WI… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
1220 Parkwood Dr
Wisconsin Rapids, WI 54494-5488
Mailing address
1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899
Other names
- MyEyeDr.
Other providers in Wisconsin Rapids, WI
- Christina May Molski
- Brandon Moul
- Lynn Mrozek
- Ridhwi Mukerji
- Meredith Mutza
- Brittany Myszka
- Francis Claire Natividad
- Gregory S Naze
- Victoria Louissa Neff
- Florence Tavera Neilitz
All providers in Wisconsin Rapids, WI · Optometrist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.