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General NPI Number Information
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NPI Number | 1518245703
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Entity Type | Organization
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Legal Business Name | GREENVILLE EYECARE LLC
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 07/22/2011
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Provider Practice Location Address
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Address Line | N1739 LILY OF THE VALLEY DR SUITE 2
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City | GREENVILLE
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State | WI
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Zip | 54942-9105
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Country | US
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Telephone | 920-560-3937
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Fax | 920-257-4403
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Provider Business Mailing Address
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Address Line | N1739 LILY OF THE VALLEY DR SUITE 2
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City | GREENVILLE
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State | WI
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Zip | 54942-9105
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Country | US
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Telephone | 920-560-3937
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Fax | 920-257-4403
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | ANDREW MAGIERA
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Credential |
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Telephone | 920-560-3937
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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 | 2994-035
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License Number State | WI
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