Individual provider Active NPI

Micki Maureen Flynn, O.D.

  • Optometrist
  • Hudson, WI
National Provider Identifier
1972552289
Registry record updated Feb 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3002-035 Issued in WI
Practice address
2215 Vine St
Suite E
Hudson, WI 54016-5802
Phone
(715) 381-1234
Fax
(715) 381-5357
NPI assigned
May 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3002-035 WI Primary

Addresses

Primary practice location

2215 Vine St
Suite E
Hudson, WI 54016-5802

Mailing address

2215 Vine Street
Suite E
Hudson, WI 54016
Phone (715) 381-1234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050208000281 WI Practitioner - Optometry 4688565294 Reassigns benefits to 1 organization
I20250328003308 MN Practitioner - Optometry 4688565294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rivertown Eye Care PAGroup PAC ID 2769452234, 3 clinicians
Aeg Wisconsin Professional LTDGroup PAC ID 1557372968, 16 clinicians

Practice addresses (Care Compare)

1011 N Frontage Rd
Hastings, MN 55033-2662
Phone (651) 437-5469

2215 Vine St
Suite E
Hudson, WI 54016-5862
Phone (715) 381-1234

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4375MAMDPsychologist
3002-035WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Wisconsin Professional LTD Optometrist CurrentSince Jul 1, 2006 Accepting new patients
Rivertown Eye Care PA Optometrist CurrentSince Apr 7, 2025 Accepting new patients
Osceola Family Eyecare LLC Optometrist Past Accepting new patients

Locations

1011 N Frontage Rd
Hastings, MN 55033
Phone (651) 437-5469

2215 Vine St
Ste E
Hudson, WI 54016
Phone (715) 381-1234

2215 Vine St
Hudson, WI 54016
Phone (715) 381-1110

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422921600000",
    "number": "1972552289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 VINE STREET",
            "address_2": "SUITE E",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "54016",
            "telephone_number": "715-381-1234",
            "fax_number": "715-381-5357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 VINE ST",
            "address_2": "SUITE E",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540165802",
            "telephone_number": "715-381-1234",
            "fax_number": "715-381-5357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYNN",
        "first_name": "MICKI",
        "middle_name": "MAUREEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-06",
        "last_updated": "2015-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3002-035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

Verify at the official NPI Registry.