Healthcare Provider Details

I. General information

NPI: 1265572564
Provider Name (Legal Business Name): EYE CARE OF WISCONSIN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 NORTH PLANKINTON AVE #730B
MILWAUKEE WI
53203
US

IV. Provider business mailing address

740 NORTH PLANKINTON AVE #730B
MILWAUKEE WI
53203
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-3030
  • Fax: 414-351-3603
Mailing address:
  • Phone: 414-351-3030
  • Fax: 414-351-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number96733
License Number StateWI

VIII. Authorized Official

Name: DR. PATRICK D CASHIN
Title or Position: CEO
Credential: O.D.
Phone: 414-351-3030