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BLAKE CHURCH OD
NPI 1104717024
Optometrist in New Berlin, WI

Active since July 09, 2025PECOS EnrolledAccepts Medicare Assignment
16800 W CLEVELAND AVE, NEW BERLIN, WI 53151(414) 313-7121 Get Directions Write a Review

NPPES record last updated: August 3, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Blake Church Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAKE CHURCH OD (NPI 1104717024) is an individual optometrist in New Berlin, Wisconsin, licensed in Wisconsin (4089-35) and active in the NPI registry since July 2025. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1104717024
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameBLAKE CHURCHCredential: OD
Location Address16800 W CLEVELAND AVENew Berlin, WI 53151-3533
Mailing Address16800 W Cleveland AveNew Berlin, WI 53151-3533
Phone(414) 313-7121
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateJuly 9, 2025
Last NPPES UpdateAugust 3, 2025
NPPES CertifiedJuly 29, 2025
✔ NPI 1104717024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in WI · 4089-35
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
16800 W CLEVELAND AVE, New Berlin, WI 53151
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Blake Church Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5395249056
PECOS Enrollment IDI20250917001115
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53151 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$123.69 typical visit price
range $53.90 – $163.24
Typical copayment $30.92 (range $13.47 – $40.81)
Most-billed visit code 99204
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WISCONSIN VISION, LLC
Optometrist
16800 W CLEVELAND AVE
NEW BERLIN, WI 53151
Waukesha County (262) 432-2005

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blake Church's NPI number?

The NPI number for Blake Church is 1104717024. It was assigned to this individual provider in the NPPES registry on July 9, 2025.

Where is Blake Church located?

Blake Church practices at 16800 W Cleveland Ave, New Berlin, WI 53151. The listed phone number is (414) 313-7121.

What is Blake Church's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Blake Church enrolled in Medicare?

Yes. Blake Church is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Blake Church accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield of Wyoming, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and Blue Cross and Blue Shield of Oklahoma and 4 other insurers list Blake Church as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Blake Church was last updated on August 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.