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General NPI Number Information
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NPI Number | 1699974980
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF GREEN BAY, SC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 2020 RIVERSIDE DR STE 201
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City | GREEN BAY
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State | WI
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Zip | 54301-2300
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Country | US
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Telephone | 920-965-7000
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Fax | 920-965-4701
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Provider Business Mailing Address
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Address Line | 2020 RIVERSIDE DR STE 201
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City | GREEN BAY
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State | WI
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Zip | 54301-2300
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Country | US
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Telephone | 920-965-7000
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Fax | 920-965-4701
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SALLY JILOT
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Credential |
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Telephone | 920-965-4800
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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