Healthcare Provider Details

I. General information

NPI: 1740273770
Provider Name (Legal Business Name): MILWAUKEE EYE CARE ASSOCIATES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17280 W NORTH AVE STE 100
BROOKFIELD WI
53045-4366
US

IV. Provider business mailing address

1684 N PROSPECT AVE
MILWAUKEE WI
53202-2498
US

V. Phone/Fax

Practice location:
  • Phone: 414-271-2020
  • Fax: 414-272-3932
Mailing address:
  • Phone: 414-271-2020
  • Fax: 414-272-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON NATHANIEL EDMONDS
Title or Position: OWNER
Credential: MD
Phone: 414-271-2020