Healthcare Provider Details

I. General information

NPI: 1457331894
Provider Name (Legal Business Name): EYE PHYSICIAN ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W. LAYTON AVE STE 100
MILWAUKEE WI
53220-5132
US

IV. Provider business mailing address

4300 W. LAYTON AVE STE 100
MILWAUKEE WI
53220-5132
US

V. Phone/Fax

Practice location:
  • Phone: 414-928-2020
  • Fax: 414-210-3402
Mailing address:
  • Phone: 414-928-2020
  • Fax: 414-210-3402

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: CHARLES B YANG
Title or Position: PRESIDENT
Credential: MD
Phone: 414-928-2020