Individual provider Active NPI

James Frederick Dusenberry, O.D.

  • Optometrist
  • Waukesha, WI
National Provider Identifier
1871539619
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2804-035 Issued in WI
Practice address
825 W Moreland Blvd
Waukesha, WI 53188-2963
Phone
(262) 542-9610
NPI assigned
Jun 21, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2804-035 WI Primary

Addresses

Primary practice location

825 W Moreland Blvd
Waukesha, WI 53188-2963

Mailing address

1145 Wenzel CT
Jefferson, WI 53549-2218
Phone (920) 988-0431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041022001003 WI Practitioner - Optometry 6406817436 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

1500 S Church St
Watertown, WI 53094-6404
Phone (920) 261-9225

6000 Monona Dr
Suite 101
Monona, WI 53716-3329
Phone (608) 222-9420

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2804-035WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Shoptikal LLC Optometrist CurrentSince Sep 25, 2023 Accepting new patients
Shoptikal LLC Optometrist Current Accepting new patients
Shoptikal LLC Optometrist CurrentSince Sep 25, 2023 Accepting new patients
Stein Optical Inc. Optometrist Past Accepting new patients

Locations

1640 Madison Ave
Fort Atkinson, WI 53538
Phone (920) 563-2171

1595 E Sumner St
Ste 108
Hartford, WI 53027
Phone (262) 709-8211

2029 Humes Rd
Janesville, WI 53545
Phone (608) 754-7411

6000 Monona Dr
Ste 101
Monona, WI 53716
Phone (608) 222-9420

110 8th St
Monroe, WI 53566
Phone (608) 328-3333

1440 Capitol Dr
Ste B
Pewaukee, WI 53072
Phone (262) 820-2656

120 N Grand Ave
Ste 102
Sun Prairie, WI 53590
Phone (608) 839-7008

1500 S Church St
Watertown, WI 53094
Phone (920) 261-9225

1166 W Sunset Dr
Ste F100
Waukesha, WI 53189
Phone (262) 574-9410

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871539619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 WENZEL CT",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535492218",
            "telephone_number": "920-988-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 W MORELAND BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882963",
            "telephone_number": "262-542-9610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUSENBERRY",
        "first_name": "JAMES",
        "middle_name": "FREDERICK",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2804-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.