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General NPI Number Information
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NPI Number | 1912023987
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Entity Type | Organization
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Legal Business Name | COMMUNITY EYECARE CENTER SC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 222 S WASHINGTON ST
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City | WAUPACA
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State | WI
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Zip | 54981-1531
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Country | US
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Telephone | 715-258-2020
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Fax | 715-258-9301
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Provider Business Mailing Address
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Address Line | 222 S WASHINGTON ST
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City | WAUPACA
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State | WI
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Zip | 54981-1531
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Country | US
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Telephone | 715-258-2020
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Fax | 715-258-9301
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY L. BYERS
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Credential | O.D.
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Telephone | 715-258-2020
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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 | 2492
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License Number State | WI
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