Todd William Wild, OD
Individual provider Active NPI Optometrist · Weyauwega, WI
NPI 1992737704 · NPPES record last updated Nov 30, 2021
Key facts
- NPI
- 1992737704
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2346 (WI)
- Practice address
- 415 E Ann St
Weyauwega, WI 54983-8532 - Phone
- (920) 867-3131
- Fax
- (920) 867-3408
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
415 E Ann St
Weyauwega, WI 54983-0350
Phone (920) 867-3131
415 E Ann St PO Box
Suite 350
Weyauwega, WI 54983-0350
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 34 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090612000223 | WI | Practitioner - Optometry | 4486704442 |
Reassigns benefits to 1 organization Practice locations: Weyauwega, WI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2346 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 1 Vision S.C. | Optometrist | Current |
Accepting new patients |
| Spectacular Visions LTD | Optometrist | Past | Accepting new patients |
Locations
136 S Main St
Clintonville, WI 54929
Phone (715) 526-3163
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2346 | WI | Yes |
Addresses
Primary practice location
415 E Ann St
Weyauwega, WI 54983-8532
Mailing address
PO Box 350
Weyauwega, WI 54983-0350
Phone (920) 867-3131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38578700 | Medicaid | WI |
Other providers in Weyauwega, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.