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General NPI Number Information
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NPI Number | 1235870155
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Entity Type | Organization
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Legal Business Name | 414 EYES
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 3925 S 76TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53220-2320
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Country | US
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Telephone | 414-543-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 2249 S ALDRICH ST
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City | MILWAUKEE
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State | WI
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Zip | 53207-1303
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Country | US
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Telephone | 504-495-3887
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JANICE FAN SMITH
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Credential | OD
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Telephone | 504-495-3887
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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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