Healthcare Provider Details

I. General information

NPI: 1376769331
Provider Name (Legal Business Name): MILWAUKEE EYE CARE ASSOCIATES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W LOOMIS RD SUITE 204
FRANKLIN WI
53132-8887
US

IV. Provider business mailing address

1684 N PROSPECT AVE
MILWAUKEE WI
53202-2408
US

V. Phone/Fax

Practice location:
  • Phone: 414-271-2020
  • Fax: 414-525-1354
Mailing address:
  • Phone: 414-271-2020
  • Fax: 414-272-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MISS KANG B YANG
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 414-271-2020