MEDICARE: FAMILY EYE CARE CENTER OF RACINE INC

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	3019-035	WI

General Provider Information

NPI Number	:	1831372333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYE CARE CENTER OF RACINE INC

Provider Business Mailing Address
First Line	:	2405 NORTHWESTERN AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53404-2534
Country	:	US
Telephone Number	:	262-634-2020
Fax Number	:	262-638-2020

Provider Business Practice Location Address
First Line	:	2405 NORTHWESTERN AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53404-2534
Country	:	US
Telephone Number	:	262-634-2020
Fax Number	:	262-638-2020

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY T PIERANGELI
Credential	:
Telephone Number	:	262-634-2020

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	01/14/2008

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