Kevin A Harry, OD
Individual provider Active NPI Optometrist · Elm Grove, WI
NPI 1821078189 · NPPES record last updated Jul 30, 2024
Key facts
- NPI
- 1821078189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2179 (WI)
- Practice address
- 15300 Watertown Plank Rd
Elm Grove, WI 53122-2300 - Phone
- (262) 786-9630
- Fax
- (262) 786-3972
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Myeyedr Optometry of Wisconsin LLC
Practice addresses (Care Compare)
15300 Watertown Plank Rd
Elm Grove, WI 53122-2300
Phone (262) 786-9630
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 15 |
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 |
|---|---|---|---|---|
| I20070305000689 | WI | Practitioner - Optometry | 9537262951 |
Reassigns benefits to 2 organizations Practice locations: Elm Grove, WI; Brookfield, WI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Wisconsin, LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Wisconsin, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Wisconsin, LLC | Optometrist | Current |
Accepting new patients |
| Family Vision & Contact Lens Centers, S.C. | Optometrist | Current |
Accepting new patients |
| Family Vision & Contact Lens CTRS SC | Optometrist | Current |
Accepting new patients |
Locations
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
17125 W Bluemound Rd
Brookfield, WI 53005
Phone (262) 786-9630
17125 W Bluemound Rd
Ste F
Brookfield, WI 53005
Phone (262) 786-9630
309 McHenry St
Burlington, WI 53105
Phone (262) 763-0117
15300 Watertown Plank Rd
Elm Grove, WI 53122
Phone (262) 786-9630
2305 30th Ave
Kenosha, WI 53144
Phone (262) 597-2020
2505 N Mayfair Rd
Ste 100
Wauwatosa, WI 53226
Phone (414) 453-7020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2179 | WI | Yes |
Addresses
Primary practice location
15300 Watertown Plank Rd
Elm Grove, WI 53122-2300
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38575400 | Medicaid | WI |
Other providers in Elm Grove, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2024. 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.