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General NPI Number Information
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NPI Number | 1871036061
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Entity Type | Organization
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Legal Business Name | EMER EYE CARE S.C.
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 3612 ROOSEVELT RD
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City | KENOSHA
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State | WI
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Zip | 53142-7230
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Country | US
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Telephone | 262-652-1689
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 ROOSEVELT RD
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City | KENOSHA
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State | WI
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Zip | 53142-7230
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Country | US
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Telephone | 262-652-1689
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETER EMER
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Credential |
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Telephone | 262-652-1689
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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 | 1725035
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License Number State | WI
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