Healthcare Provider Details

I. General information

NPI: 1386861367
Provider Name (Legal Business Name): MIDWEST EYE LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 COMMERCE VALLEY RD SUITE 201
EAU CLAIRE WI
54701-7075
US

IV. Provider business mailing address

4606 COMMERCE VALLEY RD SUITE 201
EAU CLAIRE WI
54701-7075
US

V. Phone/Fax

Practice location:
  • Phone: 715-833-2277
  • Fax: 715-833-2295
Mailing address:
  • Phone: 715-833-2277
  • Fax: 715-833-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL R BARRETT
Title or Position: PRESIDENT OCULARIST
Credential: B.C.O.
Phone: 715-833-2277