MEDICARE: MILWAUKEE EYE CARE ASSOCIATES S.C. #2

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000068570	OTHER	WI	DMERC PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740273770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILWAUKEE EYE CARE ASSOCIATES S.C. #2

Provider Business Mailing Address
First Line	:	1684 N PROSPECT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2408
Country	:	US
Telephone Number	:	414-271-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	17280 W NORTH AVE
Second Line	:	SUITE 100
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4366
Country	:	US
Telephone Number	:	414-271-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER S FOOTE
Credential	:	M.D.
Telephone Number	:	414-271-2020

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/21/2022

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