MEDICARE: BALDWIN EYE CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	156FX1201X	Optometric Assistant Technician
3	156FX1800X	Optician
4	261Q00000X	Clinic/Center
5	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000047780	OTHER		MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1548457302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALDWIN EYE CARE, LLC

Provider Business Mailing Address
First Line	:	1721 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-3161
Country	:	US
Telephone Number	:	608-837-7325
Fax Number	:	608-837-7326

Provider Business Practice Location Address
First Line	:	1721 W MAIN ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-3161
Country	:	US
Telephone Number	:	608-837-7325
Fax Number	:	608-837-7326

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	TREVOR J BALDWIN
Credential	:	OD
Telephone Number	:	608-837-7325

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	02/22/2021

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Directions to “BALDWIN EYE CARE, LLC ” Practice Location

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