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NPI Code Detail

MEDICARE: EYE & VISION CLINICS, S.C.

MEDICARE: EYE & VISION CLINICS, 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
1152W00000XOptometrist1428WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11194812099OTHERWINPI FOR MATTHEW L NELSON
21003927278OTHERWINPI FOR DAVID R DUFECK
31790731743OTHERWINPI FOR TIMOTHY J CORGAN
41881711588OTHERWINPI FOR DEPERE CLINIC

General Provider Information

NPI Number : 1447377148
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE & VISION CLINICS, S.C.
Provider Business Mailing Address
First Line : 140 SCHOOL CREEK TRL
Second Line :
City : LUXEMBURG
State : WI
Zip : 54217-1095
Country : US
Telephone Number : 920-845-5555
Fax Number : 920-845-5219
Provider Business Practice Location Address
First Line : 140 SCHOOL CREEK TRL
Second Line :
City : LUXEMBURG
State : WI
Zip : 54217-1095
Country : US
Telephone Number : 920-845-5555
Fax Number : 920-845-5219
Authorized Official
Title or Position : CLINIC MANAGER
Name : JENNIFER POTTS
Credential :
Telephone Number : 920-845-5555
Provider Enumeration Date : 03/26/2007
Last Update Date : 03/20/2015

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