Individual provider Active NPI

Joel D. Baisden, OD

  • Optometrist
  • Wauwatosa, WI
National Provider Identifier
1992867220
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2283 Issued in WI
Practice address
2505 N Mayfair Rd
#100
Wauwatosa, WI 53226-1404
Phone
(414) 453-7020
Fax
(414) 453-9980
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2283 WI Primary

Addresses

Primary practice location

2505 N Mayfair Rd
#100
Wauwatosa, WI 53226-1404

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other identifiers 1

IdentifierTypeStateIssuer
4687710001OtherWIDME

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040408000568 WI Practitioner - Optometry 5193718666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Wisconsin LLC 27 clinicians

Practice addresses (Care Compare)

2505 N Mayfair Rd
Suite 100
Wauwatosa, WI 53226-1404
Phone (414) 453-7020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2283WIMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Wisconsin, LLC Optometrist CurrentSince Sep 28, 2020 Accepting new patients
Myeyedr Optometry of Wisconsin, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Wisconsin, LLC Optometrist CurrentSince Sep 28, 2020 Accepting new patients

Locations

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

2305 30th Ave
Kenosha, WI 53144
Phone (262) 597-2020

2505 N Mayfair Rd
Ste 100
Wauwatosa, WI 53226
Phone (414) 453-7020

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": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1992867220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 N MAYFAIR RD",
            "address_2": "#100",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261404",
            "telephone_number": "414-453-7020",
            "fax_number": "414-453-9980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAISDEN",
        "first_name": "JOEL",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2023-03-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "4687710001",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.