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General NPI Number Information
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NPI Number | 1922874411
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Entity Type | Organization
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Legal Business Name | PLEASANT PRAIRIE EYECARE, INC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 7707 94TH AVE
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1955
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Country | US
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Telephone | 262-597-1042
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Fax |
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Provider Business Mailing Address
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Address Line | 3121 INDIAN CREEK DR
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-6596
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Country | US
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Telephone | 224-436-3702
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JESSICA MIN
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Credential | OD
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Telephone | 262-597-1042
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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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