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General NPI Number Information
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NPI Number | 1609839497
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Entity Type | Organization
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Legal Business Name | EYE PROSTHETICS OF WISCONSIN
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 13255 W BLUEMOUND RD 101
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City | BROOKFIELD
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State | WI
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Zip | 53005-6245
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Country | US
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Telephone | 262-754-3681
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Fax | 262-754-3682
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Provider Business Mailing Address
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Address Line | 13255 W BLUEMOUND RD 101
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City | BROOKFIELD
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State | WI
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Zip | 53005-6245
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Country | US
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Telephone | 262-754-3681
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Fax |
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Authorized Official
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Title or Position | OCULARIST
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Name | MRS. SUSAN TYNES
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Credential | B.C.O.
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Telephone | 262-754-3681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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