Healthcare Provider Details

I. General information

NPI: 1427439751
Provider Name (Legal Business Name): HANSEN FAMILY EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 94TH AVE
PLEASANT PRAIRIE WI
53158-1955
US

IV. Provider business mailing address

7707 94TH AVE
PLEASANT PRAIRIE WI
53158-1955
US

V. Phone/Fax

Practice location:
  • Phone: 262-597-1040
  • Fax: 262-597-1041
Mailing address:
  • Phone: 262-597-1040
  • Fax: 262-597-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number3369-35
License Number StateWI

VIII. Authorized Official

Name: DR. AMY HANSEN PIKO
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 262-597-1040