MEDICARE: EYE CLINIC SC

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	305R00000X	Preferred Provider Organization	18321	WI

General Provider Information

NPI Number	:	1851577829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CLINIC SC

Provider Business Mailing Address
First Line	:	7363 STATE ROAD 50
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-4516
Country	:	US
Telephone Number	:	262-248-8577
Fax Number	:	262-248-8757

Provider Business Practice Location Address
First Line	:	7363 STATE ROAD 50
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-4516
Country	:	US
Telephone Number	:	262-248-8577
Fax Number	:	262-248-8757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NICHOLAS WILLIM VEITH
Credential	:	M.D.
Telephone Number	:	262-248-8577

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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Directions to “EYE CLINIC SC ” Practice Location

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