MEDICARE: BRIGHT SIDE EYE CARE, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1673	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013007475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT SIDE EYE CARE, S.C.

Provider Business Mailing Address
First Line	:	185 W NETHERWOOD RD
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-1100
Country	:	US
Telephone Number	:	608-835-3579
Fax Number	:	608-835-5828

Provider Business Practice Location Address
First Line	:	185 W NETHERWOOD RD
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-1100
Country	:	US
Telephone Number	:	608-835-3579
Fax Number	:	608-835-5828

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MAX EDWARD MELBERG
Credential	:	OD
Telephone Number	:	608-835-3579

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	01/02/2024

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Directions to “BRIGHT SIDE EYE CARE, S.C. ” Practice Location

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