Healthcare Provider Details

I. General information

NPI: 1255510095
Provider Name (Legal Business Name): SOLBERG EYE CARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S30W24896 SUNSET DR SUITE 105
WAUKESHA WI
53189-7021
US

IV. Provider business mailing address

S30W24896 SUNSET DR SUITE 105
WAUKESHA WI
53189-7021
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-5295
  • Fax:
Mailing address:
  • Phone: 262-542-5295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number2334
License Number StateWI

VIII. Authorized Official

Name: SHANE A SOLBERG
Title or Position: OWNER
Credential:
Phone: 262-542-5295