NPIMap

Organization Active NPI

Dean Retail Services, Inc.

Doing business as SSM Health Davis Duehr Dean Eye Care

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
National Provider Identifier
1962225227
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
DEAN RETAIL SERVICES, INC.
Doing business as
SSM Health Davis Duehr Dean Eye Care
Practice address
2825 Hunters TRL Ste 200
Portage, WI 53901-3429
Phone
(608) 745-3933
Fax
(608) 745-3055
NPI assigned
Nov 5, 2024
Last updated
Nov 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Amy Jo Grinnell
Title
Vice President Finance
Phone
(608) 260-3586

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

2825 Hunters TRL Ste 200
Portage, WI 53901-3429

Mailing address

1808 W Beltline Hwy
Madison, WI 53713-2334
Phone (609) 294-6218

Other names 1

  • SSM Health Davis Duehr Dean Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250416001581 WI DME Supplier - Optician 5395863773 Practice locations: Portage, WI

Other NPIs with the same Medicare PAC ID 20

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Dean Eye Care-Lancaster21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2825 Hunters Trl
Portage, WI 53901
Phone (608) 742-5522

NPI Registry JSON

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

{
    "created_epoch": "1730764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1962225227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 W BELTLINE HWY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537132334",
            "telephone_number": "609-294-6218",
            "fax_number": "608-250-1384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 HUNTERS TRL STE 200",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013429",
            "telephone_number": "608-745-3933",
            "fax_number": "608-745-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN RETAIL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-05",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "GRINNELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "608-260-3586"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Davis Duehr Dean Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portage, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; 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.