Family Vision & Contact Lens CTRS SC
Organization Active NPI Optometrist · Twin Lakes, WI
NPI 1831364090 · NPPES record last updated Feb 22, 2010
Key facts
- NPI
- 1831364090
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- FAMILY VISION & CONTACT LENS CTRS SC
- Practice address
- 308 E Main St
Twin Lakes, WI 53181-9682 - Phone
- (262) 877-3999
- Fax
- (262) 877-9862
- NPI assigned
- Apr 28, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- FAMILY VISION & CONTACT LENS CTRS SC
Authorized official
- Name
- Dr. Robert Lawrence Fait, OD
- Title
- Owner
- Phone
- (262) 763-0117
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 4
Practitioners 5
-
Brandon Arthur Begotka, O.D.
-
Nicholas C Bowen, OD
-
Timothy J Hell, OD
-
Timothy M Pritzl, OD
-
Delaney Kent, OD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Eye Site |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930068188 | WI | DME Supplier - Physician - Optometrist | 9133135734 | Practice locations: Twin Lakes, WI |
National Provider Directory
- Tax ID family
- David M Ebley OD
- Part of
- David M Ebley OD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
308 E Main St
Twin Lakes, WI 53181-9682
Mailing address
PO Box 630
Burlington, WI 53105-0630
Phone (262) 763-0117
Other providers in Twin Lakes, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2010. 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.