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General NPI Number Information
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NPI Number | 1831372333
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CARE CENTER OF RACINE INC
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 2405 NORTHWESTERN AVE
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City | RACINE
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State | WI
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Zip | 53404-2534
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Country | US
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Telephone | 262-634-2020
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Fax | 262-638-2020
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Provider Business Mailing Address
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Address Line | 2405 NORTHWESTERN AVE
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City | RACINE
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State | WI
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Zip | 53404-2534
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Country | US
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Telephone | 262-634-2020
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Fax | 262-638-2020
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY T PIERANGELI
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Credential |
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Telephone | 262-634-2020
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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 | 3019-035
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License Number State | WI
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