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General NPI Number Information
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NPI Number | 1710905781
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Entity Type | Organization
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Legal Business Name | EYE CENTERS OF RACINE AND KENOSHA LTD
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 13200 GLOBE DR STE 216
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City | MT PLEASANT
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State | WI
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Zip | 53177-1605
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Country | US
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Telephone | 262-637-0500
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Fax | 262-635-8027
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Provider Business Mailing Address
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Address Line | 3805B SPRING ST SUITE 140
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City | RACINE
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State | WI
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Zip | 53405-1641
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Country | US
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Telephone | 262-637-0500
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Fax | 262-635-8027
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MELISSA GOTTFREDSEN
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Credential |
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Telephone | 262-898-5673
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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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