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General NPI Number Information
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NPI Number | 1477659456
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Entity Type | Organization
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Legal Business Name | ADVANCED EYECARE, SC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 300 E MILL ST
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City | PLYMOUTH
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State | WI
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Zip | 53073-1804
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Country | US
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Telephone | 920-893-8474
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Fax | 920-893-8814
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Provider Business Mailing Address
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Address Line | 300 E MILL ST
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City | PLYMOUTH
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State | WI
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Zip | 53073-1804
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Country | US
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Telephone | 920-893-8474
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Fax | 920-893-8814
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | TAMMY M ANHALT
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Credential |
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Telephone | 920-893-8474
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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 | 2461
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License Number State | WI
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