MEDICARE: SUSSEX EYE CARE CENTER 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	152W00000X	Optometrist	1707	WI

General Provider Information

NPI Number	:	1962653485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSSEX EYE CARE CENTER SC

Provider Business Mailing Address
First Line	:	PO BOX 144
Second Line	:
City	:	SUSSEX
State	:	WI
Zip	:	53089-0144
Country	:	US
Telephone Number	:	262-246-8066
Fax Number	:	262-246-9600

Provider Business Practice Location Address
First Line	:	N63W23524 SILVER SPRING DR
Second Line	:	SUITE 2
City	:	SUSSEX
State	:	WI
Zip	:	53089-3833
Country	:	US
Telephone Number	:	262-246-8066
Fax Number	:	262-246-9600

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. CHRISTOPHER R WINTER
Credential	:	OD
Telephone Number	:	262-246-8066

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/22/2010

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