Wautoma Eye Clinic S.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2056 Issued in WI

Legal business name

WAUTOMA EYE CLINIC S.C.

Practice address

N2577 Plaza Rd
Wautoma, WI 54982-7706

Phone

(920) 787-3837

Fax

(920) 787-1613

NPI assigned

Mar 20, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian L. Meckelberg, ODNPI 1013993393

Title

Owner

Phone

(920) 787-3837

Specialties & licenses 1

Addresses

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, and the practitioner matching its NPPES authorized official.

• Brian L Meckelberg, OD

  • Optometrist
  • Wautoma, WI
  • NPI 1013993393
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972628584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "address_2": "N2577 PLAZA ROAD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549820366",
            "telephone_number": "920-787-3837",
            "fax_number": "920-787-1613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2577 PLAZA RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549827706",
            "telephone_number": "920-787-3837",
            "fax_number": "920-787-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUTOMA EYE CLINIC S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MECKELBERG",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-787-3837",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waushara County (Waushara County Crisis Intervention)
• Waushara County Government (Waushara Co Dept of Human Services)
• Waushara Dental Associates S.C.
• Waushara Industries, Inc.
• Wautoma Area School District
• Wautoma Hometown Pharmacy LLC (Wautoma Hometown Pharmacy)
• Melissa Weasner, RDH
• Bailey L Wehrle, AT
• Sarah Welk
• Jeffrey James White, PHARMD

• Optometrist in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.