Healthcare Provider Details

I. General information

NPI: 1578456372
Provider Name (Legal Business Name): STYLED EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N82W15340 APPLETON AVE
MENOMONEE FALLS WI
53051-3777
US

IV. Provider business mailing address

N82W15340 APPLETON AVE
MENOMONEE FALLS WI
53051-3777
US

V. Phone/Fax

Practice location:
  • Phone: 262-255-5752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DEBRA GALLE
Title or Position: OWNER
Credential:
Phone: 262-255-5754