Healthcare Provider Details

I. General information

NPI: 1811508773
Provider Name (Legal Business Name): DEWINTER EYE CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S73W16437 JANESVILLE RD
MUSKEGO WI
53150-9723
US

IV. Provider business mailing address

PO BOX 547
MUSKEGO WI
53150-0547
US

V. Phone/Fax

Practice location:
  • Phone: 262-679-1420
  • Fax:
Mailing address:
  • Phone: 262-679-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DANIEL J DEWINTER
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 262-679-1420