Roxanne Doyle Keszo, OD
Individual provider Active NPI Optometrist · Shawano, WI
NPI 1821063009 · NPPES record last updated May 11, 2022
Key facts
- NPI
- 1821063009
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2963-035 (WI)
- Practice address
- 150A County Rd B
Shawano, WI 54166-7072 - Phone
- (715) 526-3163
- Fax
- (715) 526-4019
- NPI assigned
- Feb 21, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ferris State College - College of Optometry, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shoptikal LLC
Practice addresses (Care Compare)
2325 Neva Rd
Antigo, WI 54409-2912
Phone (715) 623-3620
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040211000114 | WI | Practitioner - Optometry | 7012801004 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2963-035 | WI | MD | Optometrist |
| 2963 | WI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Spectacular Visions LTD | Optometrist | Past | Accepting new patients |
| Jorgensen, Schulz and Associates Eyecare Center, SC | Optometrist | Past |
Accepting new patients |
Locations
2325 Neva Rd
Antigo, WI 54409
Phone (715) 623-3620
1640 Appleton Rd
Menasha, WI 54952
Phone (920) 725-3752
6000 Monona Dr
Ste 101
Monona, WI 53716
Phone (608) 222-9420
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2963-035 | WI | Yes |
Addresses
Primary practice location
150A County Rd B
Shawano, WI 54166-7072
Mailing address
PO Box 513
Shawano, WI 54166-0513
Phone (715) 526-3163
Other providers in Shawano, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2022. 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.
- Order and Referring (CMS).
- 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.