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General NPI Number Information
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NPI Number | 1578705919
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Entity Type | Organization
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Legal Business Name | FIRST EYECARE, PC
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 411 PEWAUKEE RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-5886
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Country | US
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Telephone | 262-695-3191
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Fax | 262-695-3806
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Provider Business Mailing Address
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Address Line | 108 S REGENCY CIR
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City | OCONOMOWOC
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State | WI
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Zip | 53066-9240
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Country | US
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Telephone | 262-695-3191
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Fax | 262-695-3806
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Authorized Official
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Title or Position | OPTOMETRIST / PRESIDENT
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Name | DR. CHRISTOPHER SAEID ENVANI
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Credential | OD
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Telephone | 262-695-3191
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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 | 2579-035
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License Number State | WI
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