Healthcare Provider Details

I. General information

NPI: 1912801945
Provider Name (Legal Business Name): MVP VISION GROUP, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 HWY 70 STE 102
MINOCQUA WI
54548-9769
US

IV. Provider business mailing address

16800 W CLEVELAND AVE
NEW BERLIN WI
53151-3533
US

V. Phone/Fax

Practice location:
  • Phone: 715-358-3937
  • Fax: 715-358-7677
Mailing address:
  • Phone: 630-335-3043
  • Fax: 630-225-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PAUL H BASTERMAJIAN
Title or Position: PRESIDENT
Credential: OD
Phone: 630-335-3043