Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blake Church, OD

Individual provider Optometrist · NPI 1104717024

Blake Church, OD is an Optometry in New Berlin, Wisconsin. Qualified in 2024, 2 years ago. Practices with Wisconsin Vision, LLC, a 27-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
2
Licensed in
WI
In the registry since
2025
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

16800 W Cleveland Ave
New Berlin, WI 53151-3533
Phone: (414) 313-7121
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence 4089-35 (WI)

Record details

NPI number1104717024
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorNo
NPI enumeratedJuly 9, 2025
Last updated in NPPESAugust 3, 2025
Certification dateJuly 29, 2025
Mailing address16800 W Cleveland Ave, New Berlin, WI 53151-3533

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Wisconsin Vision, Llc — 27 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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