Jamie Lynn Ertl, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3033035 Issued in WI

Practice address

723 Main Ave
De Pere, WI 54115-1371

Phone

(920) 336-3390

NPI assigned

Oct 28, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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.

• Shoptikal LLC

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159

  Optometrist, WI

  Medicare reassignment NPD
• Shoptikal LLC

  • Eyewear Supplier
  • West Bend, WI
  • NPI 1922664358

  Optometrist

  NPD
• Shoptikal LLC

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD
• America'S Best Contacts & Eyeglasses

  • Optician
  • Green Bay, WI
  • NPI 1700202538
  NPD (past)
• Bellin Memorial Hospital Inc

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390
  NPD (past)
• Shopko Stores Operating Co LLC

  • Community/Retail Pharmacy
  • Eau Claire, WI
  • NPI 1720034176
  NPD (past)
• Shoptikal LLC

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1194381509

  Optometrist

  NPD (past)
• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621036800000",
    "number": "1952392003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 MAIN AVE",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151371",
            "telephone_number": "920-336-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 MAIN AVE",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151371",
            "telephone_number": "920-336-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERTL",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2021-05-15",
        "certification_date": "2021-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3033035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38645400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Empower Play, LLC
• Energize Health and Wellness
• Victoria Engels, LPC
• Heather Erfurt, MS, LAT, CES
• Amina Erickson
• Hennah J Etter, LPC
• Jenna Rose Evans, CRNA
• Danielle M Evenson, LCSW
• Exceptional Equestrians Company
• Eye & Vision Clinics, S.C.

• All providers in De Pere, WI
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.