=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144035585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEY M MEDSKER ABOC, NCLEC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2950 NEW PINERY RD
-----------------------------------------------------
City | PORTAGE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53901-9225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-745-6877
-----------------------------------------------------
Fax | 608-745-6864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2950 NEW PINERY RD
-----------------------------------------------------
City | PORTAGE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53901-9225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FC0800X
-----------------------------------------------------
Taxonomy Name | Contact Lens Technician/Technologist
-----------------------------------------------------
License Number | 258949
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FC0801X
-----------------------------------------------------
Taxonomy Name | Contact Lens Fitter
-----------------------------------------------------
License Number | 258949
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 258949
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------