Provider Demographics
NPI:1063587038
Name:EYE CARE SPECIALISTS, S.C.
Entity type:Organization
Organization Name:EYE CARE SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-321-7520
Mailing Address - Street 1:10150 W NATIONAL AVE
Mailing Address - Street 2:S-100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2145
Mailing Address - Country:US
Mailing Address - Phone:414-321-7520
Mailing Address - Fax:414-321-9383
Practice Address - Street 1:735 W WISCONSIN AVE
Practice Address - Street 2:S-400
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2413
Practice Address - Country:US
Practice Address - Phone:414-298-0099
Practice Address - Fax:414-298-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207W00000X207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty