Stateline Vision Center LLC
NPI 1104219039ActiveOrganization· Optometrist· Monroe, WI
Optometrist in Monroe, Wisconsin, registered in NPPES in March 2015. The authorized official on file is Andrew M. Josephs, O.D., Sole Proprietor. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104219039 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 17, 2015 |
| Last updated in NPPES | Sep 16, 2020 |
| Certified by provider | Sep 16, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Optometrist Primary | 152W00000X | 3082 | WI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WI) |
|---|
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