MEDICARE: EYE PHYSICIAN ASSOCIATES, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0264580001	OTHER	WI	DME
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174217178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE PHYSICIAN ASSOCIATES, S.C.

Provider Business Mailing Address
First Line	:	4300 W. LAYTON AVE
Second Line	:	STE 100
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4136
Country	:	US
Telephone Number	:	414-260-0789
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 WEST LAYTON AVENUE
Second Line	:	STE 100
City	:	GREENFIELD
State	:	WI
Zip	:	53220-5132
Country	:	US
Telephone Number	:	414-928-2020
Fax Number	:	414-210-3402

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CHARLES B YANG
Credential	:	MD
Telephone Number	:	414-928-2020

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	03/19/2024

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Directions to “EYE PHYSICIAN ASSOCIATES, S.C. ” Practice Location

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