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General NPI Number Information
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NPI Number | 1174217178
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Entity Type | Organization
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Legal Business Name | EYE PHYSICIAN ASSOCIATES, S.C.
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 4300 WEST LAYTON AVENUE STE 100
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City | GREENFIELD
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State | WI
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Zip | 53220-5132
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Country | US
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Telephone | 414-928-2020
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Fax | 414-210-3402
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Provider Business Mailing Address
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Address Line | 4300 W. LAYTON AVE STE 100
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City | GREENFIELD
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State | WI
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Zip | 53220-4136
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Country | US
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Telephone | 414-260-0789
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHARLES B YANG
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Credential | MD
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Telephone | 414-928-2020
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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 | 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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