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General NPI Number Information
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NPI Number | 1962653485
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Entity Type | Organization
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Legal Business Name | SUSSEX EYE CARE CENTER SC
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | N63W23524 SILVER SPRING DR SUITE 2
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City | SUSSEX
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State | WI
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Zip | 53089-3833
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Country | US
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Telephone | 262-246-8066
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Fax | 262-246-9600
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Provider Business Mailing Address
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Address Line | PO BOX 144
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City | SUSSEX
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State | WI
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Zip | 53089-0144
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Country | US
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Telephone | 262-246-8066
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Fax | 262-246-9600
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. CHRISTOPHER R WINTER
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Credential | OD
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Telephone | 262-246-8066
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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 | 1707
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License Number State | WI
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