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General NPI Number Information
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NPI Number | 1437768876
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Entity Type | Organization
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Legal Business Name | WISCONSIN OPTOMETRIC EYE DOCTOR, INC.
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | N2577 PLAZA RD # WI-73
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City | WAUTOMA
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State | WI
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Zip | 54982-7706
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Country | US
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Telephone | 920-787-3837
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Fax |
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Provider Business Mailing Address
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Address Line | N2577 PLAZA RD # WI-73
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City | WAUTOMA
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State | WI
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Zip | 54982-7706
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Country | US
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Telephone | 920-787-3837
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | ERIC RICHARD TYLER
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Credential |
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Telephone | 651-206-2418
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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