Healthcare Provider Details

I. General information

NPI: 1639957723
Provider Name (Legal Business Name): ONYX EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S 108TH ST
MILWAUKEE WI
53214-4012
US

IV. Provider business mailing address

3350 S 98TH ST
MILWAUKEE WI
53227-4214
US

V. Phone/Fax

Practice location:
  • Phone: 414-526-9935
  • Fax:
Mailing address:
  • Phone: 414-526-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. TREVOR LEE THOMAS
Title or Position: OWNER
Credential:
Phone: 414-526-9935