Ethan Everett Huisman, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

02216 Issued in IA

Practice address

1350 SE University Ave
Waukee, IA 50263-8933

Phone

(515) 987-3937

Fax

(515) 987-3930

NPI assigned

Nov 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Eye Care PCGroup PAC ID 0446383327, 10 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Elite Eye Care PC

  • Optometrist
  • Waukee, IA
  • NPI 1700103850
  Medicare reassignment Care Compare group Authorized official
• KNJ Optometry PLC

  • Optometrist
  • Ankeny, IA
  • NPI 1568819647
  NPD
• Insight Vision Inc.

  • Optometrist
  • Marion, IA
  • NPI 1316912579
  NPD (past)
• Russell R Gist OD PC

  • Optometrist
  • Ankeny, IA
  • NPI 1700831492
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1891776365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 SE UNIVERSITY AVE",
            "city": "WAUKEE",
            "state": "IA",
            "postal_code": "502638933",
            "telephone_number": "515-987-3937",
            "fax_number": "515-987-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 SE UNIVERSITY AVE",
            "city": "WAUKEE",
            "state": "IA",
            "postal_code": "502638933",
            "telephone_number": "515-987-3937",
            "fax_number": "515-987-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUISMAN",
        "first_name": "ETHAN",
        "middle_name": "EVERETT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Hinchliff
• Jennifer L. Hohrmann, P.T.
• Sarah Campbell Holland, D.O.
• Cristina Lynn Holtorf, MSN, ARNP, FNP-BC
• Caitlin Lillian Hornback
• Brian David Hunziker, DPM
• Hy-Vee Inc
• Iadakne Medical
• Infinex Healthcare LLC
• Infinity Chiropractic Center LLC

• Optometrist in Waukee, IA
• Providers in Waukee, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.