MEDICARE: DOOR COUNTY EYE ASSOCIATES, INC

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	1895	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	410040654	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	613054200	OTHER	WI	U. S. DEPT OF LABOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	38519100	OTHER	WI	HEALTH INSURANCE RISK SHARE PLAN

General Provider Information

NPI Number	:	1356391718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOOR COUNTY EYE ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	165 N 3RD AVE
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-2415
Country	:	US
Telephone Number	:	920-743-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 N 3RD AVE
Second Line	:
City	:	STURGEON BAY
State	:	WI
Zip	:	54235-2415
Country	:	US
Telephone Number	:	920-743-2020
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JOHN ERIC PAULSEN
Credential	:	O.D.
Telephone Number	:	920-743-2020

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	05/21/2008

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Directions to “DOOR COUNTY EYE ASSOCIATES, INC ” Practice Location

Language	Start Address	Practice Location

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