DR WAGNER SOUTHRIDGE OPTICAL LLC (NPI# 1255591236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255591236 |
| Entity Type | Organization |
| Organization Name | DR WAGNER SOUTHRIDGE OPTICAL LLC |
| Practice Address |
5300 S 76th St Ste 690 Greendale WI 53129-1102 |
| Practice Telephone | 4148550469 |
| Practice Fax Number | 4148550492 |
| Mailing Telephone | 4148550469 |
| Mailing Fax Number | 4148550492 |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2009-08-17 |
| Authorized Official Name | MRS. JOAN E SERRANO (MANAGER) |
| Authorized Official Telephone | 4148550469 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Street Address |
5300 S 76TH ST STE 690 |
| City | GREENDALE |
| State | WI |
| Zip Code | 53129-1102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538192380 | Thomas L. Prichard | Optometrist | 5300 S 76th St, Greendale, WI 53129-1102 | 2006-07-07 |
| 1295139129 | Nebojsa Vesic | Optometrist | 5300 S 76th St, Greendale, WI 53129-1102 | 2014-10-21 |
| 1285911727 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 5300 S 76th St, Greendale, WI 53129-1102 | 2011-11-11 |
| 1902026206 | James P Wagner | Optometrist | 5300 S 76th St, Ste 690, Greendale, WI 53129-1102 | 2007-04-27 |
| 1205977733 | John Monty | Optometrist | 5300 S 76th St, Greendale, WI 53129-1102 | 2007-02-09 |
| 1336285998 | Pearle Vision Inc | Optometrist | 5300 S 76th St, Greendale, WI 53129-1102 | 2007-01-30 |
| 1447316468 | Michael Lindemeyer | Optometrist | 5300 S 76th St, Greendale, WI 53129-1102 | 2006-12-28 |
| 1548341597 | Stein Optical Inc | Eyewear Supplier (Equipment, not the service) | 5300 S 76th St, Greendale, WI 53129-1102 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225579253 | Jewel E Schneider | Nurse Practitioner | 6801 Southway, Greendale, WI 53129 | 2017-03-09 |
| 1578019782 | Kristina Copeland | Nurse Practitioner | 6220 West Loomis Road, Greendale, WI 53129 | 2016-08-28 |
| 1568713162 | Monica A Judge | Acupuncturist | 5651 Broad Street, Greendale, WI 53129 | 2012-09-24 |
| 1295867364 | Allen Curphey Owen | Dentist | 5310 W Loomis Rd, Greendale, WI 53129 | 2007-03-12 |
| 1689720583 | Terry Michael Hough | Chiropractor | 5800 Broad St, Greendale, WI 53129 | 2007-01-25 |
| 1730282815 | Lindsay Kathryn Heus | Speech-Language Pathologist | 5405 W Loomis Rd, Greendale, WI 53129 | 2006-09-06 |
| 1477900561 | Therapy At Home LLC | Physical Therapist | 7711 Freeland Ct, Greendale, WI 53129 | 2016-05-18 |
| 1972871606 | Tony J Matuszak | Optometrist | 5497 S 76th St, Greendale, WI 53129 | 2011-12-08 |
| 1750589990 | Lisa Anne Balge | Occupational Therapist | 3111 West Rawson Avenue, Suite 215, Franklin, WI 53129 | 2007-07-10 |
| 1497282255 | Mobile Occupational Health and Wellness Urgent Care Solutions | Clinic/Center | 5055 S 84th St, Greendale, WI 53129-1006 | 2017-05-11 |
| Find all providers in zip 53129 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568569564 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 5200 S 76th St, Southridge Mall, Greendale, WI 53129-1116 | 2006-09-20 |
| 1598787533 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 5350 S 76th St, Greendale, WI 53129-1126 | 2006-07-25 |
| 1790717361 | America's Best Contacts & Eyeglasses | Eyewear Supplier (Equipment, not the service) | 5497 S 76th St, Greendale, WI 53129-1130 | 2006-07-06 |
| 1285911727 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 5300 S 76th St, Greendale, WI 53129-1102 | 2011-11-11 |
| 1548341597 | Stein Optical Inc | Eyewear Supplier (Equipment, not the service) | 5300 S 76th St, Greendale, WI 53129-1102 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658772 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1073 E Johnson St, Fond Du Lac, WI 54935-8919 | 2020-10-27 |
| 1578170247 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 120 N Grand Ave Ste 102, Sun Prairie, WI 53590-9007 | 2020-09-28 |
| 1639784622 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2268 W Mason St, Green Bay, WI 54303-4707 | 2020-09-15 |
| 1427669746 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1607 Losey Blvd S, La Crosse, WI 54601-6151 | 2020-08-11 |
| 1710598032 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 631 Hometown Cir Ste 106, Verona, WI 53593-1561 | 2020-08-11 |
| 1871138073 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 723 Main Ave, Depere, WI 54115 | 2019-11-12 |
| 1558903815 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 422 Gammon Pl, Madison, WI 53719-1026 | 2019-10-08 |
| 1669013256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 123 N Mall Dr, Grand Chute, WI 54913-8531 | 2019-10-04 |
| 1952962763 | Martell Eyecare, LLC | Eyewear Supplier (Equipment, not the service) | 703 Third Street, Marathon, WI 54448 | 2019-06-23 |
| 1932767316 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1440 Capital Drive, Suite B, Pewaukee, WI 53072 | 2019-05-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.