Stateline Vision Center LLC
NPI 1104219039 · Optometrist · Monroe, WI
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Stateline Vision Center LLC is a Optometrist organization in Monroe, WI (NPI 1104219039).
Provider details
- NPI number
- 1104219039
- Entity type
- Organization
- Primary specialty
- OptometristEye and Vision Services Providers
- Organization subpart
- No
- Authorized official
- Andrew Josephs, Sole Proprietor(608) 325-7200
- License
- 3082 (WI)
Specialties & taxonomies
Eye and Vision Services Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2015-03-17
- Last updated
- 2020-09-16
- Certified
- 2020-09-16
Frequently asked questions
- What is Stateline Vision Center LLC's NPI number?
- Stateline Vision Center LLC's National Provider Identifier (NPI) is 1104219039, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Stateline Vision Center LLC?
- Stateline Vision Center LLC is classified in the NPPES registry as Optometrist (Eye and Vision Services Providers).
- Where is Stateline Vision Center LLC located?
- Stateline Vision Center LLC's practice location on file with NPPES is 250 N 18th Ave Ste 105, Monroe, WI 53566-1482.
- What is Stateline Vision Center LLC's phone number?
- The practice phone number listed in the NPPES registry for Stateline Vision Center LLC is (920) 216-3133.
- Does Stateline Vision Center LLC accept Medicare?
- Stateline Vision Center LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Stateline Vision Center LLC?
- The authorized official listed on Stateline Vision Center LLC's NPPES record is Andrew Josephs, Sole Proprietor. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Stateline Vision Center LLC's NPI active?
- Yes — Stateline Vision Center LLC's NPI (1104219039) is active in the NPPES registry as of the last update on 2020-09-16.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.