Provider Demographics
NPI:1063173128
Name:ADVANCED RETINA S.C.
Entity type:Organization
Organization Name:ADVANCED RETINA S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-573-5946
Mailing Address - Street 1:4131 W LOOMIS RD STE 240
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2072
Mailing Address - Country:US
Mailing Address - Phone:262-510-0300
Mailing Address - Fax:262-510-0500
Practice Address - Street 1:4131 W LOOMIS RD STE 240
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2072
Practice Address - Country:US
Practice Address - Phone:262-510-0300
Practice Address - Fax:262-510-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-31
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty