Petrou-Haefs Eyecare, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

2387-035 Issued in WI

Legal business name

PETROU-HAEFS EYECARE, LLC

Practice address

7040 N Port Washington Rd
Suite 420
Glendale, WI 53217-3885

Phone

(414) 839-8379

NPI assigned

Feb 12, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Christina Petrou, ODNPI 1912945338

Title

Optometrist

Phone

(414) 839-8379

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Petrou Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christina Marie Petrou, O.D.

  • Optometrist
  • Glendale, WI
  • NPI 1912945338
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1329004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329004800000",
    "number": "1891068599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7040 N PORT WASHINGTON RD",
            "address_2": "SUITE 420",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173885",
            "telephone_number": "414-839-8379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7040 N PORT WASHINGTON RD",
            "address_2": "SUITE 420",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173885",
            "telephone_number": "414-839-8379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETROU-HAEFS EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-12",
        "last_updated": "2012-02-12",
        "status": "A",
        "authorized_official_last_name": "PETROU",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "414-839-8379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "2387-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "385755400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petrou Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Lauren Pavelsek, OTR
• Kristen Paxson
• Larissa Lynn Perry, LMT
• Personal Care Solutions LLC
• Holly Marie Pete, C.O.T.A.
• Christina Marie Petrou, O.D.
• Physiological Health Sanctuary LLC
• Pin Point Transportation LLC
• Kyle James Piscitello, PHARMD
• Frances B Pitt, MSW

• Clinic/Center in Glendale, WI
• Providers in Glendale, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.