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General NPI Number Information
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NPI Number | 1073285912
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Entity Type | Organization
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Legal Business Name | MEDICAL EYE ASSOCIATES, S.C.
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 201 N MAYFAIR RD STE 525
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City | WAUWATOSA
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State | WI
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Zip | 53226-4216
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Country | US
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Telephone | 262-547-3352
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 DELAFIELD ST STE 312
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City | WAUKESHA
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State | WI
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Zip | 53188-3407
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Country | US
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Telephone | 262-506-1627
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KAYLA MCCULLOUGH
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Credential |
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Telephone | 262-506-1627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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