Healthcare Provider Details

I. General information

NPI: 1548457302
Provider Name (Legal Business Name): BALDWIN EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 W MAIN ST
SUN PRAIRIE WI
53590-3161
US

IV. Provider business mailing address

1721 W MAIN ST
SUN PRAIRIE WI
53590-3161
US

V. Phone/Fax

Practice location:
  • Phone: 608-837-7325
  • Fax: 608-837-7326
Mailing address:
  • Phone: 608-837-7325
  • Fax: 608-837-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TREVOR J BALDWIN
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 608-837-7325