Healthcare Provider Details

I. General information

NPI: 1265155006
Provider Name (Legal Business Name): MD VISION SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 DOCTORS CT
OSHKOSH WI
54901-2077
US

IV. Provider business mailing address

719 DOCTORS CT
OSHKOSH WI
54901-2077
US

V. Phone/Fax

Practice location:
  • Phone: 920-235-0066
  • Fax:
Mailing address:
  • Phone: 920-235-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL VRABEC
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 920-915-8810