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General NPI Number Information
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NPI Number | 1225791973
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Entity Type | Organization
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Legal Business Name | EYES ON THE LAKE
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 2134 S KINNICKINNIC AVENUE
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City | MILWAUKEE
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State | WI
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Zip | 53207-1379
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Country | US
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Telephone | 414-293-1180
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Fax | 414-293-1181
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Provider Business Mailing Address
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Address Line | 2134 S KINNICKINNIC AVENUE
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City | MILWAUKEE
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State | WI
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Zip | 53207-1379
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Country | US
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Telephone | 414-293-1180
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Fax | 414-293-1181
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Authorized Official
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Title or Position | OPTOMETRIST / OWNER
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Name | DR. VAUGN SCHNEIDER
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Credential | OD
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Telephone | 920-850-1367
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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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