Active NPI
Robert L Wegner, O.D.
- Optometrist
- Racine, WI
National Provider Identifier
1861516262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1310
- Practice address
- 1120 Grove Ave
Racine, WI 53405-3028 - Phone
- (262) 637-7917
- Fax
- (262) 637-6786
- NPI assigned
- Mar 19, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1310 | WI | Primary |
Addresses
Primary practice location
1120 Grove Ave
Racine, WI 53405-3028
Mailing address
1120 Grove Ave
Racine, WI 53405-3028
Phone (262) 637-7917
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38570200 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1310 | WI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1861516262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 GROVE AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534053028",
"telephone_number": "262-637-7917",
"fax_number": "262-637-6786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 GROVE AVE",
"city": "RACINE",
"state": "WI",
"postal_code": "534053028",
"telephone_number": "262-637-7917",
"fax_number": "262-637-6786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEGNER",
"first_name": "ROBERT",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-19",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "1310",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38570200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.