Healthcare Provider Details

I. General information

NPI: 1427347822
Provider Name (Legal Business Name): EYE PHYSICIAN ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 03/20/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 W LIEBAU RD SUITE 102
MEQUON WI
53092-3396
US

IV. Provider business mailing address

4300 W. LAYTON AVE STE 100
GREENFIELD WI
53220-4136
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-3001
  • Fax: 262-243-3006
Mailing address:
  • Phone: 414-260-0789
  • Fax: 414-210-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3427120
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4492620
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4839520
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number3867120
License Number StateWI

VIII. Authorized Official

Name: DR. CHARLES YANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-928-2020