=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730359654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE CARE CENTER LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2008
-----------------------------------------------------
Last Update Date | 02/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 346 MAIN ST
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53530-0154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-776-4413
-----------------------------------------------------
Fax | 608-776-4414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 154 346 MAIN ST
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53530-0154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-776-4413
-----------------------------------------------------
Fax | 608-776-4414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT SOLE OWNER
-----------------------------------------------------
Name | DR. PAUL C LUECK
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 608-776-4413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1849
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------