MEDICARE: EYE CARE SURGICAL CONSULTING, 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	207W00000X	Ophthalmology Physician	44898-020	WI
2	207W00000X	Ophthalmology Physician	26907-020	WI

General Provider Information

NPI Number	:	1578606810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE SURGICAL CONSULTING, S.C.

Provider Business Mailing Address
First Line	:	4060 N MAIN ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3121
Country	:	US
Telephone Number	:	262-752-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 N MAIN ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-3121
Country	:	US
Telephone Number	:	262-752-2020
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JODY R LAPORTE
Credential	:	M.D.
Telephone Number	:	262-752-2020

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	02/19/2009

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Directions to “EYE CARE SURGICAL CONSULTING, S.C. ” Practice Location

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