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General NPI Number Information
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NPI Number | 1114084324
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Entity Type | Organization
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Legal Business Name | TWO RIVERS EYE CLINIC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 1603 WASHINGTON ST
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City | TWO RIVERS
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State | WI
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Zip | 54241-3021
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Country | US
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Telephone | 920-793-2725
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1900
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City | MANITOWOC
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State | WI
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Zip | 54221-1900
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Country | US
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Telephone | 920-684-4429
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Fax | 920-684-6892
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DR. STEVEN P GAINEY
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Credential | M.D.
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Telephone | 920-684-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 44214-020
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License Number State | WI
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