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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	C01777	OTHER		RAILROAD MEDICARE

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	=========	OTHER		HUMANA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	=========	OTHER		UNITED HEALTH CARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000073822	OTHER	WI	MILWAUKEE PTAN
9	=========	OTHER	WI	BLUE CROSS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	=========	OTHER	WI	COMPCARE
14	0264580001	OTHER		DMEPOS ASSIGNED
15	73605	OTHER	WI	WISCONSIN PHYSICIAN SERVI

General Provider Information

NPI Number	:	1457331894
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	:	MILWAUKEE
State	:	WI
Zip	:	53220-5132
Country	:	US
Telephone Number	:	414-928-2020
Fax Number	:	414-210-3402

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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES B YANG
Credential	:	MD
Telephone Number	:	414-928-2020

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	11/06/2024

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