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

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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