Crandon Vision Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

1494-035 Issued in WI

Legal business name

CRANDON VISION CENTER

Practice address

103 E Washington St
Crandon, WI 54520-1392

Phone

(715) 478-2401

Fax

(715) 478-3663

NPI assigned

Sep 20, 2006

Last updated

Jul 10, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jean Ann Whitt-Barker

Title

Office Manager

Phone

(715) 478-2401

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1861590200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 E WASHINGTON ST",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545201392",
            "telephone_number": "715-478-2401",
            "fax_number": "715-478-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 E WASHINGTON ST",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545201392",
            "telephone_number": "715-478-2401",
            "fax_number": "715-478-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRANDON VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "WHITT-BARKER",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "715-478-2401"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1494-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38553700-38703000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Anne Conway
• Stephanie Marie Coons, DSW
• County of Forest
• Crandon Area Rescue Squad, Inc
• Crandon Chiropractic S.C.
• Kristin Mary Dahms
• Shelby Lynn Daniels, SAC-IT
• Jolene A Derfus, SAC-IT
• Laura Donatelle, DNP APRN FNP
• Tanya Ann Doyle, LPCC

• Optometrist in Crandon, WI
• Providers in Crandon, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.

Verify at the official NPI Registry.